Make a Friends of the Society Certification Award nomination

Name of Branch

Email details in case of a discrepancy

I wish to apply for (state number below) Friends of the Society Certificates which will be presented on behalf of the Branch to:

Nomination 1

Name of individual/group/club etc

Brief reason for issue:

Nomination 2

Name of individual/group/club etc

Brief reason for issue:

Nomination 3

Name of individual/group/club etc

Brief reason for issue:

Nomination 4

Name of individual/group/club etc

Brief reason for issue:

Nomination 5

Name of individual/group/club etc

Brief reason for issue:

Nomination 6

Name of individual/group/club etc

Brief reason for issue:

Nomination 7

Name of individual/group/club etc

Brief reason for issue:

Nomination 8

Name of individual/group/club etc

Brief reason for issue:

Applicants Details

Name

Office held by applicant:

Return Address

Postcode

Required by (date):

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