This form must reach the Beacon Fellowship Charitable Trust at 1st Floor, Holborn Gate, 330 High Holborn, London WC1V 7QT, by 1st July 2008. Please read the accompanying Guidance and Conditions of Entry note before completing this form.

SECTION A

About the nominee

I nominate the following person for the Beacon Prize 2008:

*Surname			Title		Mr Mrs Miss Dr Rev
*Forename(s)			Honours/Awards
*Gender		Select... Male Female
Address
Town			County
Country			Postcode
Date of birth		Day 01020304050607080910111213141516171819202122232425262728293031 Month JanFebMarAprMayJunJulAugSepOctNovDec Year 19081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008
Telephone number			Facsimile number if known
E-mail address if known
*I would like to nominate the above for the following Beacon Prize: Please carefully consider which prize category you are making the nomination for and tick only one box. Nominations with more than one box ticked will not be considered.
Beacon Prize for Community Builder Beacon Prize for Young Philanthropist Beacon Prize for New Initiatives Beacon Prize for Creative Giving Beacon Prize for Leadership
*Area of Benefit	Select... Abuse Intervention Animals Arts Children Community Conservation Education Elderly Faith Human Rights International Development Medical/Health Palliative Care Poverty Social Care Social Enterprise Youth Other