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Awards Referral
THIS IS NOT A NOMINATION FORM.
This form enables you to refer to us, someone that you think deserves an award.
From this referral, we will send them a nomination link to nominate themselves.
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* Indicates required question
Your name (First and Last Name)
*
Your answer
Provide your frequently used phone number
*
Your answer
Provide your frequently used email address
*
Your answer
What is the full name of the person you're referring?
*
Tell us their names in order of FIRST and LAST name
Your answer
Provide their frequently used phone number
*
Your answer
Provide their frequently used email address
*
Your answer
Is there a specific category you are referring this person for?
*
Yes
No
Select the category for which you are referring this candidate (not more than two)
*
Black Impact All Rounder Award
Black Impact Academic Excellence Award
Black Impact Creative Award
Black Impact Entrepreneur Award
Black Impact Innovator Award
Black Impact Leadership Award
Black Impact Resilience Award
Black Impact Social Media Influencer Award
Black Impact Social Activist Award
Black Impact Sports person Award
Required
Terms and Conditions
*
Yes, I agree with Black Impact's Terms & Conditions as displayed on the Black Impact website
Required
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