Form – Proposing a candidate for a blue plaque

Name of person/event you wish to be commemorated with a plaque

Specific location of the proposed plaque

Does the original building still exist? Does the original building still exist? Yes No

Brief account of the life of the person/event and the reason for the plaque: (100 words max)

Link between the person/event to be commemorated and the building

Name

Email Address

Phone

Address

Any additional information (do not include supportive images or documents at this stage)