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Nomination Application
Malaysian Indian Women Icon Booking
Full Name
Salutation
Tan Sri
Puan Sri
Datuk Seri
Datin Seri
Datuk
Datin
Dr
Miss
Mrs
Phone
Email
Complete Address
Postcode
State
Johor
Kedah
Kelantan
Kuala Lumpur
Labuan
Malacca
Negeri Sembilan
Pahang
Penang
Perak
Perlis
Putrajaya
Sabah
Sarawak
Selangor
Terengganu
Company Name
Position
Linkedin URL
Choice of Category for Icon
Academic
Activist
Civil Service
Corporate
Entrepreneurship
Entertainment
Politics
Professional
Social Worker
Sports
Have you received any Awards, Recognition before? If yes, what is the Name(s) of Award or Recognition and the Awarding Body(s)
Have you been on any other publications before? If yes, what are they?
Please attach a profile of yours ( can also be newspaper clippings or any others)
Please attach a high resolution full body or half body photograph of yourself
Please attach a high resolution photo of profession or business
Give a short write up about yourself , explaining key achievements, accomplishments and involvements. (you may disregard this if you have attached your profile earlier)
Choice of Package. Please refer accompanying message for privileges
EXCLUSIVE Package - 2 pages
PREMIER Package - 1 page
I confirm to be featured in "Malaysian Indian Women Icon ", which is the first ever Coffee Table exclusively for Indian Women.
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