Send your nomination

Please fill in all fields in the form below. After submitting the form you will receive a copy of your entry by email.

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Name of nominee
Age (must be 40 or under)
Gender
How can we contact them?
Project or type of work in which they have been involved
Headline (in a short sentence or phrase, sum up why you’re nominating them - max 150 characters)
An outline of the work they have been engaged in, including an assessment of the impact they have had (max 1000 characters)
What makes them an exceptional leader and role model (max 750 characters)
Name of Nominator
Email of Nominator
Telephone of Nominator
Relationship of Nominator to Nominee (if any)
Any relevant supporting links (media features, interviews, testimonials)

References

Referee 1 (mandatory)
Name
Email
Telephone
Referee 2 (optional)
Name
Email
Telephone

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