KALPANA CHAWALA AWARD NOMINATION FORM
Registration has closed
Nomination Type
*
Self
Email
*
Email should not be blank
Nomination by other individuals
Name of the person Nominating
*
Email should not be blank
Email
*
Email should not be blank
Reason for choosing nominee name
*
Email should not be blank
Mobile Number
*
Enter mobile number without country code
Mobile should not be blank
Nomination by Organisation/ Company
Name of Organisation/ Company
*
Name of Organisation/ Company should not be blank
Address of Organisation/ Company
*
Address should not be blank
Email
*
Email should not be blank
Mobile Number
*
Enter mobile number without country code
Mobile should not be blank
Reason for choosing nominee name
*
Reason should not be blank
Nomination by association
Name of association
*
Name of association should not be blank
Address of association
*
Address should not be blank
Email
*
Email should not be blank
Mobile Number
*
Enter mobile number without country code
Mobile should not be blank
Reason for choosing nominee name
*
Reason should not be blank
Select one option
Nominee Information
Nominee Name
*
Name should not be blank
Category of nomination
*
Science & Technology
Academics
Entrepreneurship & Industry
Arts & Sports
Select Category of nomination
Date of Birth
*
Select Date of Birth
UAE experience (in years)
*
UAE experience should not be blank
Email
*
Please make sure email-id is correct. OTP will be sent on this email-id
Email should not be blank
Mobile
*
Enter mobile number without country code
Mobile should not be blank
Mobile length is not 10 digit
Name of the emirate
*
Select Emirate
Abu Dhabi
Ajman
Al Ain
Dubai
Fujairah
Ras Al Khaimah
Sharjah
Umm Al Quwain
Select the Emirate
Social Media Handles
LinkedIn
Enter the URL
Twitter
Enter the URL
Facebook
Enter the URL
Youtube
Enter the URL
Other 1
Enter the URL
Other 2
Enter the URL
Passport size photograph
*
Upload the file
Upload the file in jpg/png/jpeg format
Profile and Write-up about nominees' outstanding contribution (pdf format only)
*
File size should be less than 3 MB.
Upload the file
Upload the file in pdf format
If email otp did not received please also check spam folder
Enter Confirmation OTP Sent On Email-id :
OTP
*
OTP should not be blank
Please enter correct OTP
Resend
Session Id :
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