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* 1. Name of Sponsor:

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* 2. Address and phone number:

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* 3. Email Address:

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* 4. Category of Award Nomination (please tick as many boxes as you would like)

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* 5. Individual's name as well as category:

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* 6. Their contact details (preferably email):

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* 7. Tell us why you feel this person or organisation should receive this Award. The information you provide here will be used by the judging panel so tell us what you think we need to know. Tell us what they have done and why this is impressive: tell us about their enthusiasm, the impact they have had on the community, how they have gone beyond the expected, or any barriers they have overcome.

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