Welcome to the nomination form for the 2017 Cure Leukaemia Champions Awards to recognise all of our incredible fundraisers in such a vital year. Please make your nominations below and remember if you want to nominate more than one person, you can do so by filling the form in again!

Question Title

* 1. Your full name:

Question Title

* 2. Your email address:

Question Title

* 3. Your telephone number:

Question Title

* 4. The name of the person you are nominating:

Question Title

* 5. The award(s) you are nominating them for:

Question Title

* 6. Why should this person win the award? (500 words Max)

Question Title

* 7. Twitter handle of the nominee (If they have one)

Question Title

* 8. Email address of the nominee (If you know it)

Nominations close on Tuesday 31st October 2017 and the Trustees of Cure Leukaemia will judge each category winner!

This year's event takes place on Friday 15th December at Hotel du Vin in Birmingham from 2pm.

T