Category entered: PLEASE TICK APPROPRIATE BOX

Category entered:

PLEASE TICK APPROPRIATE BOX

YOUR DETAILS

Name

Address:

Telephone number (day):

Telephone number (evening):

Mobile number:

Email:

GROUP DETAILS

Name of group/ individuals

Area covered(ie Baillieston, West End)

Contact at group

Contact address:

Email:

Web address:

Telephone number (day):

Telephone number (evening):

Mobile number:

What are the main activities of the group/individual?

How has this individual or group made an impact on the local community?

If nominating an individual, tell us about the person and the special qualities he/she has?

FOR GROUP ENTRIES

What are the main aims of the group?

What is the group's greatest achievement to date?

Please list any additional information:

Attach relevant literature/ documents to the nomination