8/17/2019 AFRICA 2016 Nomination Form

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N A T I O N A L G E O G RA P H I C S O C I E T Y /   B U F F E T T A W A R D  

F O R L E A D E R S H IP I N A F R I C A N C O N S E R V A T I O N  

Nominations must be received by January 22, 2016. Please complete and email this form along with the

nominee’s CV, if available, to:

Luisa Arnedo, PhD

National Geographic Society

conservationtrust@ngs.org 

Part I Nominator’s Information

Nomination submitted by

Title, Organization ,

Email address, Telephone ,

Part II Nominee’s Information

Last (family) name

First (given) name

Title

Organization

Street address

State/Province, Postal code ,

Country

Telephone, Fax ,

E-mail address

For how many years has the

nominee worked inconservation?

What other major awards has

the nominee been given?

Part III Nominator’s Statement

Please describe the nominee’s major achievement(s) in conservation (2-page limit)