KAILASA Om Awards Nomination Form

1Nominee Details

2Details of the person filling out this form

3Details for the Nomination

Title

Name *

First

Last

Country of residence: *

Phone

Website (if available):

Address

Address Line 1

City

State / Province / Region

Postal Code

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.

For which KAILASA award are you nominating the candidate?

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

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

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

Short biography of the nominee which would be presented during the award ceremony and posted on social media

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

Click or drag a file to this area to upload.

Any other relevant additional material

Click or drag a file to this area to upload.

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.