This survey is now CLOSED. Thank you for your interest. Please visit http://timelessconference.com for updates on the Timeless Women Awards.
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* 1. What is the name of a woman in your community, workplace or in your circles who is making a difference?

* 2. Please enter her telephone number.

* 3. Please enter her email address.

* 4. Please enter her other contact details.

* 5. In which category is your nominee making a difference? You may select more than one category.

* 6. In what way is this nominee making a difference in society?

Thank you for taking your time to complete the nominations process.

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