Nomination Form

Full Name: *

Designation:*

Organization/Institute:*

Email:*

Mobile Number:*

Location:*

Date of Birth:*

Twitter Handle:*

Linkedin URL:*

Nominating for:

Are you an Equalifi Individual Member or work for any Equalifi Corporate/Academic Member?

Please tell us in 250 words or less why you you should be considered for this recognition

Enter this captcha below : 250