Nominate

Nominate a place where you feel Swajal WaterATM can have an impact. Based on our nominations, we will try match potential sponsors.

[contact-form to=”advait.k@swajal.in”][contact-field label=”Name” type=”name” required=”1″][contact-field label=”Email” type=”email” required=”1″][contact-field label=”Nomination Location” type=”textarea” required=”1″][contact-field label=”How many people can get impacted?” type=”select” required=”1″ options=”0-1000,1000-5000,5000-10000,10000+”][contact-field label=”How do you know of this place?” type=”select” required=”1″ options=”Live Here,Have Visited,Know About It”][contact-field label=”What kind of a place is it?” type=”select” required=”1″ options=”School,Hospital,Station,City,Village,Slum,Other”][contact-field label=”What kind of water issue is there?” type=”checkbox-multiple” required=”1″ options=”No water available,No clean drinking water available,Expensive water,Water has bad quality”][contact-field label=”Your Phone Number” type=”text” required=”1″][/contact-form]