Make a preliminary nomination

Your details

Your Email (required)

Your Name (required)

Your Address

Your Town (required)

Your County (required)

Your Postcode (required)

Your Email (required)

You must provide at least one of home/work/phone numbers.

Phone number(s)

Please select one of the following categories:*

Nominee's name

Nominee's address

Nominee's town

Nominee's county

Nominee's postcode

Nominee's email address

You must provide at least one of the following numbers.

Nominee's phone no(s)

In no more than 200 words, describe why you believe your nomination satisfies the criteria of this Award: