Nominate site for a Green Wheel/Certificate

Fields marked with an asterisk (*) are compulsory.

Name of site being nominated *:

Address/Location of site *:

Owner of site *:

Name of Owner *:

Address of Owner:

Owner's Email *:

Owner's Phone:

Why does the site merit a Green Wheel/Certificate? *:

Please describe the sustainability measures in place at the site and the benefits they bring.

What are the key features that justify it receiving a Green Wheel/Certificate? *:

Where should the plaque (if applicable) be mounted?:

Is this location visible to people passing by?:

Is the site listed or otherwise protected? *:

How accessible is the site and the proposed location for the plaque or certificate? *:

Nominator's Name *:

Nominator's Address:

Nominator's Email *:

Relationship of the nominator to the owner of the site *:

Does the nominator have the owner's permission to make the nomination? *:

Yes No

Is sponsorship available to support the cost of making the plaque?:

Yes No Maybe

Is the owner able and willing to mount the plaque at their own expense?:

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