兔子先生

Blue plaque nomination form

About your nomination
1. Name of person / building you are nominating*
2. Where do you think the plaque should be located?*
  Please include a specific address, including postcode
3. Do you have permission from the building owner to install the plaque?*
  
  Yes
  
  No
  
  Not yet
  We can only award nominations that have permission from the building owner
4. Why are you nominating this person or building?*
5. Explain how the person / building has made a significant contribution to the culture or history of South Tyneside*
6. Please include any more information you think is relevant
Your details
2. Your name
  1. Title*
  2. Title*
  3. First name*
  4. Last (family) name*
3. Your email
  1. Email address
  2. Confirm email address
4. Phone number*