Erewash Borough Council

Active Lives in Erewash nomination form

Active Lives form

All fields marked with an Asterix (*) must be completed.  If there are any issues completing this form please call 0115 907 2244 extension 3963. For a paper version of the form email Kathleen.Taylor@erewash.gov.uk

 

Please choose which award you are nominating for
Please let us know your name.
Please enter an address
Please enter a valid postcode
Invalid Input
Please let us know your name.
Please enter an address
Please enter a valid postcode
Please let us know your email address.
Invalid Input
select yes or no
Please let us know your reason for nominating

Data Protection: This form is not secure. Please don't include any confidential or sensitive information on it. Erewash Borough Council (EBC) collects personal information when you contact us for services we provide. We use this information to provide the services requested. We may need to share your information with other organisations or EBC departments to ensure service delivery. This is made clear in our privacy notice. We will not share your information with any other third parties, unless required to do so by law. For more information on how we protect & use your data, visit www.erewash.gov.uk/privacy.