INDIA EMPIRE NRI AWARDS NIGHT Awards Home











Nomination Form

Thank you for choosing to file your nomination. Please fill out the form in detail.

The nomination fee is US$ 20.00.

For the 2010 Awards we were able to select the best from across the world (see Web Page for INDIA EMPIRE NRI AWARDS 2010 on www.indiaempire.com).

NOMINATION FORM FOR AWARDS
(Please fill only one form per person. Fill up online and submit)

1. Please choose the category (ies) you are nominating:
Business Leadership

(Use SHIFT, CTRL or CONTROL key to select more than one category)

Community Services Leadership

(Use SHIFT, CTRL or CONTROL key to select more than one category)

Youth Segment

(Use SHIFT, CTRL or CONTROL key to select more than one category)

Special Categories

(Use SHIFT, CTRL or CONTROL key to select more than one category)

2. Initials    Other (Please Specify)

Name of Nominee:          

Phone Number:                

Full Postal Address:        

Citizen of (Country):         

Email:                                   

(Filling in all categories is a necessity)

4. Please spell out reason for nomination in not more than 250 words.


5. Whether nominee is in a position to travel to New Delhi, India in and around January 10, 2010 on his / her own in order to receive award?
Yes   No

6. Other distinctions nominee may have received in the past?


7. Kindly provide names of two referees with contact details.
Reference 1 Name:    Phone Number:

Reference 2 Name:    Phone Number:



Thank you.