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Nomination Form - Organisation

Southwark Civic Association                                             
Organisation Nomination Form

Please add as much detail as possibly can, as the decision of the association will be based solely on this form.

Note: Only one nomination per 30 min period is allowed.
Before you complete this form please review the criteria information.




Nomination Form for an Organisation
Your First name  *
Your Last name  *
Your Address  *
Your Phone No.  *
Your E-mail  *
Name of organisation being nominated:
Address of organisation being nominated:
City
County
Post Code
Type of organisation ie Charity, Voluntary or Business  *
Your relationship to the person, ie friend, you MUST NOT be related:  *
Add as much informnation as you can here
Do you work for Southwark Council or are you a member of the Southwark Civic Association?
If required please contact me by: Email or Telephone  *
* Required fields



Please note that Southwark Civic Association is an independent, non political organisation. Please ensure that your nominations are not for political organisations or representatives.

 

 © 2012 Southwark Civic Association

© 2011 Southwark Civic Association