NOMINATION FORM

Simply complete the form below.

Which individual do you think is so inspiring they deserve to be recognised in our Directory?  They can be of any age, from any walk of life and from any part of the UK, but the one thing they must be is extraordinary and made a transformational lasting change to both the Muslim community and society at large. The person must have made a lasting impact , a tireless charity fundraiser or an exemplary teacher, scientist or engineer. People who go that extra mile. You can even nominate yourself if you feel you deserve recognition. Note – Information provided as part of the nomination may be used as part of an editorial feature in the media. Our committee decision is final and no correspondence will be entered into with the suitability We support no political view or interests, and have no governmental ties.

Your Name:

Your Address:

Your daytime Telephone No:

Your Email Address:

Name of Inspiring Muslim:

Category:

IM Address:

IM Telephone:

IM Email:

Photo:

What they have achieved:

Their Impact & Influence on Humanity:

Evidence / Research / Articles / Website / Books / Reference:

I hereby declare that the information declared in this nomination form is current, true and correct

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