Nomination Form

Nominee Details

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


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