KAILASA Om Awards Nomination Form

Details of the person you wish to Nominate

Title:

Full Legal Name (First Name, Last Name):

Country of residence:

Email address:

Phone number:

Website (if available):

Street Address:

Unit #:

City:

Zip code/ Postal code:

Country:

Please note that the award certificate and gift will be shipped to the above address if the nominee is selected as a laureate.
We request that the nomination remains confidential. The nominee should not be made aware of the nomination at any point until their nomination has been approved by the board.

Details of the person filling out this form

Name:

Email Address:

Phone Number:

Which KAILASA ecosystem are you part of? (If applicable):

Details for the Nomination

For which KAILASA award are you nominating the candidate?

Briefly describe your relationship with the nominee (if applicable).

words. Please limit to 100 words or less With Space.

Describe how the nominee contributes to the community and humanity at large.

words. Please limit to 1500 words or less With Space.

What are the reasons that make you believe the nominee is a good candidate for the KAILASA OM Award?

words. Please limit to 500 words or less With Space.

Short biography of the nominee which would be presented during the award ceremony and posted on social media
words. Please limit to 150 words or less With Space.

Profile picture of the nominee which will be presented during the award ceremony and posted on social media

Please attach relevant additional material such as a resume (required), news articles (if applicable), letters of support (optional) or other material. *Additional materials should be combined and submitted as one PDF and should not exceed 8 pages.