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NEWCASTLE UNDER LYME

CIVIC SOCIETY AND BOROUGH COUNCIL

CIVIC AWARDS NOMINATION FORM

Closing date 1st August 2009

Name of Scheme…………………………………………………………………

Site Address………………………………………………………………………..

…………………………………………………………………………………..…….

Category [A [i], A [ii], B [i],B [ii] or C ] …………………………………

Reasons for nomination……………………………………………………….

……………………………………………………………………………………………..

………………………………………………………………………………………………

………………………………………………………………………………………………

Owner of scheme [if known]………………………………………….……………

Architect / Designer [ if known ]………………………………..………………

Nominated by Name…………………………………………….…………………..

Address………………………………………………………………………………….

 ………………………………………………………………………………………….

……………………………………………………………………………..……………..

Tel:…………………………………………………………………………….…….

E-mail:…………………………………

Date………………………………….

Number of Photographs enclosed (See attached Guidelines) …………….

N.B. Photographs will only be returned if specifically requested.

Completed form to be returned before 1st August 2009 to

Civic Awards Scheme,

10 Kingsway East,

Newcastle-under-Lyme,

Staffordshire,

ST5 3PZ

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