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ORGANISED BY
Warrington Disability Partnership

SUPPORTED BY
Northwest Regional Development Agency
Investing in England Northwest

IN PARTNERSHIP WITH
Disability Awareness Day

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Nomination Form

Please use this form to nominate the the business, organisation or individual which you think should receive a Positive Action Award. Try to give as much information as possible. Any contact details you provide, for both yourself and your nominee, will be kept strictly confidential.

Closing date is 23rd August 2010. Awards Evening will take place on 30th September 2010 at The Halliwell Jones Stadium.

My nomination for a Positive Action Award 2010 is:

Name of Business, Organisation or Individual

Their Address:




Their Telephone Number(if known):

Their Email Address (if known):

I think my nominee should receive an award because:

Please give us contact details about yourself. This information will be used only to verify your entry and to clarify details in your nomination. We regret that we cannot accept anonymous nominations, or nominations with false contact details.

My Name is:

My Business or Organisation (if applicable):

My Address:




My Telephone Number:

My Email Address(if applicable):

I am willing to attend the award ceremony if my nomination is successful:

 Yes
 No

 

Please do not enter any website addresses into this form. Due to increasing amounts of spam, any submissions containing website addresses or which appear to be advertisments of any description will be blocked. -->

 
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