If you are nominating a plaque to commemorate more than one person, please complete this section fully for each individual, using separate forms for each. Nominee's title(required) Nominee's first name(required) Nominee's surname(required) Profession or Occupation(required) Company or organisation Date of Birth(required) Date of Death(required) Please give a brief account of the life and achievements of the person you are nominating.(required) Please explain why you believe this person deserves a plaques, and how they meet the criteria.(required) Please supply details of the nominee’s other key honours (titles, awards, etc) and memorials (other plaques, statues, street names, etc) of which you are aware. (required) Please add any references or links to other information that you think will help us in our research and decision-making. (required) Please list any additional attachments concerning the individual and suggested addresses (documents, images etc) that you are submitting. Please list all local address(es) associated with the nominee of which you are aware, including post code. (required) Are any of the proposed addresses your property? If so, please indicate which (required) Please provide any details you have on the nature of the association of the nominee(s) with the named address(es). For example, was this address a residence or work place? Did they undertake work of particular significance whilst there? When were they connected with these properties? (Provide dates if possible). (required) Briefly, please provide any information you have about the building(s), such as date, architect and builder. (required) Please confirm that, as far as you are aware, the suggested address(es) are the original buildings associated with the nominee(s). Are you aware of any large-scale works at the suggested addresses since the proposed individual was associated with them? We do not consider ‘sites’ of now-demolished buildings, or properties with significantly altered appearances or facsimile frontages. (required) Do you have photographs of the property you can forward to us?(required) Yes. (Please send these via WeTransfer.com to ladyplaques.beestoncivicsoc@gmail.com) No Do you have photographs of the nominee you can forward to us?(required) Yes. (Please send these via WeTransfer.com to ladyplaques.beestoncivicsoc@gmail.com) No SUBMIT NOMINATION Δ
Beeston Civic Society 