Nomination -

Name of individual or group (required) *

First

Last

If you are nominating a group please list all names, ages and dates of birth on a separate sheet.

Address (required) *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Daytime Tel No (required) *

Nominee Email (required) *

Date of Birth (required) *//

Name of individual or group (required) *

First

Last

Address (required) *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Daytime Tel No (required) *

Your Email (required) *

Your relationship with nominee

e.g Group leader, parent etc

Please tick each box to confirm:

I am over 18 years of age
My nominee has been involved in helping the local community and has not received any form of reward or payment
Approval has been given by the parent/guardian
I agree that if my Nominee is shortlisted for the Award then the information I have provided about the Nominee maybe circulated to the Press, Social Media, published or recited at the Awards Ceremony.

Ref 1 Name *

First

Last

Daytime tel No *

Email address *

Please describe how your nominee has contributed to their community, an individual, or an organisation. (maximum 200 words) *

What specific impact have your nominee's actions had on their community, an individual, or an organisation. (maximum 200 words) *

Provide any additional information that highlight the significance of your nominee's contributions. (maximum 200 words) *

Nominators can send any further information or photographs you feel the panel might like to see, by email or post using the following details:

Email – lanpac@lancashire.police.uk

Post – LANPAC Office, Lancashire Constabulary HQ, Saunders Lane, Hutton, Preston, Lancashire, PR4 5SB

Cookie	Duration	Description
cookielawinfo-checbox-analytics	11 months	This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Analytics".
cookielawinfo-checbox-functional	11 months	The cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Functional".
cookielawinfo-checbox-others	11 months	This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Other.
cookielawinfo-checkbox-necessary	11 months	This cookie is set by GDPR Cookie Consent plugin. The cookies is used to store the user consent for the cookies in the category "Necessary".
cookielawinfo-checkbox-performance	11 months	This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Performance".
viewed_cookie_policy	11 months	The cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. It does not store any personal data.