Please nominate your Irish startup. Please include as much information as possible. The startup must have been started in last 24 months.<form method="post" action="http://www.emailmeform.com/fid.php?formid=436236" enctype="multipart/form-data" accept-charset="UTF-8">
<table cellpadding="2" cellspacing="0" border="0" bgcolor="#FFFFFF">
<tr>
<td>
<font face="Verdana" size="2" color="#000000">Silicon Ireland Magazine Startups Nomination Form </font>
 <div style="" id="mainmsg"> </div>

</td>
</tr>
</table>

<br>

<table cellpadding="2" cellspacing="0" border="0" bgcolor="#FFFFFF">

<tr valign="top">
 <td nowrap><font face="Verdana" size="2" color="#000000">Your Name</font></td>
 <td><input type="text" name="FieldData0" size="30"> </td>
</tr>

<tr valign="top">
 <td nowrap><font face="Verdana" size="2" color="#000000">Your Email Address</font></td>
 <td><input type="text" name="FieldData1" size="30"> </td>
</tr>

<tr valign="top">
 <td nowrap><font face="Verdana" size="2" color="#000000">Startup Being Nominated (web Address )</font></td>
 <td><input type="text" name="FieldData2" size="60"> </td>
</tr>

<tr valign="top">
 <td nowrap><font face="Verdana" size="2" color="#000000">Startups Founder s name (if known)</font></td>
 <td><input type="text" name="FieldData3" size="60"> </td>
</tr>

<tr valign="top">
 <td nowrap><font face="Verdana" size="2" color="#000000">Date started (if known)</font></td>
 <td><input type="text" name="FieldData4" size="30"> </td>
</tr>

<tr valign="top">
 <td nowrap><font face="Verdana" size="2" color="#000000">Anything we should know about the startup?</font></td>
 <td><textarea name="FieldData5" cols="60" rows="10"></textarea><br> </td>
</tr>

<tr>
 <td colspan="2">
</td>
</tr>
<tr>
 <td>
 </td>
 <td align="right">
<input type="text" name="hida2" value="" maxlength="100" size="3" style="display : none;">
<input type="submit" class="btn" value="Send Form" name="Submit">&nbsp; &nbsp; <input type="reset" class="btn" value="  Clear  " name="Clear"></td>
</tr>
<tr>
<td colspan=2 align="center">
<br>
</td>
</tr>
</table>

</form>Your details will not be passed on to a third party. Visit http://siliconireland.blogspot.com