Thank you for nominating an outstanding pharmacy assistant!
Once you have submitted the nomination form, we will contact the nominee to let them know they have been nominated.
We will also let them know you nominated them and why.
Your Details
Your First Name
*
(required)
Your Last Name
*
(required)
Your Email Address
*
(required)
Your Contact Phone Number
Your Relationship to the Nominee
*
(required)
Guild Staff
Banner Group Representative
Employer
Colleague / Peer
Retail Manager
Pharmacist / Manager
Customer
Pharmaceutical Representative
Other
If 'Other' Please Specify
How did you hear about the Pharmacy Assistant of the Year Award? (please tick all that apply)
*
(required)
APP
Banner Group
Colleague / Peer
Email
Facebook
Fax
I was a previous nominee
In-store
Industry / Pharmaceutical Rep
myCPD
My Learning
Online advertising
PA Conference
PATY Website
Pharmacy Guild Staff
Post Script
Print Advertising
PA News
Pharmacy Guild website / communication
Other
If 'Other' Please Specify
Nominee Details
Nominee First Name
*
(required)
Nominee Surname
*
(required)
Nominee Contact Number
Nominee Email Address
Pharmacy where nominee is currently employed
*
(required)
Pharmacy Suburb
*
(required)
Nominee's Position
Pharmacy Assistant
Dispensary Assistant
Senior Pharmacy Assistant
Retail Manager
Dispensary Manager
Other
If 'Other' Please Specify
Pharmacy Details
Employer's Name
Pharmacy Address
Pharmacy State
*
(required)
-- Please Select --
ACT
NSW
NT
QLD
SA
TAS
VIC
WA
Pharmacy Postcode
Pharmacy Email Address
Is this Pharmacy part of a Banner Group?
*
(required)
Yes
No
Unsure
If yes, which Banner Group?
-- Please Select --
Advantage Pharmacy Group
AFS Friendly Care
Alliance Pharmacy
Amcal
Amcal Chempro
APHS
API
Auscare
Better Health Pharmacies
Blooms
Calanna
Capital Chemist
Chemist Warehouse
Chemmart
Coral Coast
Delahunty's
Direct Chemist Outlet
Discount Drug Store
Discount Pharmacy Group
Douglas Group
Foote Group
Good Price Pharmacy
Guardian
Harrison's
Health Etc.
Health Information Pharmacy
Healthpoint
HealthSave
Healthwise
Healthy Pharmacy
Healthyworld Pharmacy
Infinity Pharmacy Group
Ioannidis Pharmacy Group
Jadin Group
Life Pharmacy Group
LiveLife
Malouf Group
Neilson Martin Pharmacy Group
Nexus Group
Optimal Pharmacy Plus
Pharmacist Advise
Pharmacy Alliance
Pharmacy4Less
Pinnacle
Priceline
Retail Pharmacy Group
Scaffidis
Simply Pharmacy Group
Soul Pattinson
Tabiano Family
Terry White Chemmart
Think Group
United Discount Chemists
Wizard Pharmacy
Nomination
Why are you nominating the above pharmacy assistant for this Award?
*
(required)
Terms & Conditions
*
(required)
I acknowledge that I have read and agreed to abide by the terms and conditions of entry.
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