Nomination Form
Please fill out this form to nominate a Black individual (you can nominate yourself!) who has impacted your community through their organizing, artistry, or healing work. This person will become eligible to receive a free self-care support kit with items made and curated by the Palm Wine Collective! You can also choose to nominate them to receive a healing service!
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Name of Nominee *
Why are you nominating this person? (2-3 sentences) *
What would you want them to receive? *
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