<div id="et_pb_contact_form_1" class="et_pb_module et_pb_contact_form_1 et_pb_contact_form_container clearfix" data-form_unique_num="1" data-redirect_url="https://energycouncil.com/awards-of-excellence-nominations-2019/"><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <div class="et-pb-contact-message"></div><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <div class="et_pb_contact"><!-- [et_pb_line_break_holder] --> <form class="et_pb_contact_form clearfix" method="post" action="https://go.pardot.com/l/126031/2019-04-12/6kpb8w"><!-- [et_pb_line_break_holder] --> <p class="et_pb_contact_field et_pb_contact_field_3 et_pb_contact_field_half" data-id="your_email_address" data-type="email"><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <label for="et_pb_contact_your_email_address_1" class="et_pb_contact_form_label">Your Email Address</label><!-- [et_pb_line_break_holder] --> <input type="text" id="et_pb_contact_your_email_address_1" class="input" value="" name="et_pb_contact_your_email_address_1" data-required_mark="required" data-field_type="email" data-original_id="your_email_address" placeholder="Your Email Address"><!-- [et_pb_line_break_holder] --> </p><p class="et_pb_contact_field et_pb_contact_field_4 et_pb_contact_field_half et_pb_contact_field_last" data-id="name_of_nominee" data-type="input"><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <label for="et_pb_contact_name_of_nominee_1" class="et_pb_contact_form_label">Name of Nominee</label><!-- [et_pb_line_break_holder] --> <input type="text" id="et_pb_contact_name_of_nominee_1" class="input" value="" name="et_pb_contact_name_of_nominee_1" data-required_mark="required" data-field_type="input" data-original_id="name_of_nominee" placeholder="Name of Nominee"><!-- [et_pb_line_break_holder] --> </p><p class="et_pb_with_border et_pb_contact_field et_pb_contact_field_5 et_pb_contact_field_last" data-id="reason_for_nomination" data-type="text"><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <label for="et_pb_contact_reason_for_nomination_1" class="et_pb_contact_form_label">Reason for Nomination</label><!-- [et_pb_line_break_holder] --> <textarea name="et_pb_contact_reason_for_nomination_1" id="et_pb_contact_reason_for_nomination_1" class="et_pb_contact_message input" data-required_mark="required" data-field_type="text" data-original_id="reason_for_nomination" placeholder="Reason for Nomination" spellcheck="false"></textarea><!-- [et_pb_line_break_holder] --> </p><!-- [et_pb_line_break_holder] --> <input type="hidden" value="et_contact_proccess" name="et_pb_contactform_submit_1"><!-- [et_pb_line_break_holder] --> <input type="text" value="" name="et_pb_contactform_validate_1" class="et_pb_contactform_validate_field"><!-- [et_pb_line_break_holder] --> <div class="et_contact_bottom_container"><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <div class="et_pb_contact_right"><!-- [et_pb_line_break_holder] --> <p class="clearfix"><!-- [et_pb_line_break_holder] --> <span class="et_pb_contact_captcha_question">12 + 10</span> = <input type="text" size="2" class="input et_pb_contact_captcha" data-first_digit="12" data-second_digit="10" value="" name="et_pb_contact_captcha_1" data-required_mark="required"><!-- [et_pb_line_break_holder] --> </p><!-- [et_pb_line_break_holder] --> </div> <!-- .et_pb_contact_right --><!-- [et_pb_line_break_holder] --> <button type="submit" class="et_pb_contact_submit et_pb_button">Submit</button><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <input type="hidden" id="_wpnonce-et-pb-contact-form-submitted" name="_wpnonce-et-pb-contact-form-submitted" value="9ab23b6c6f"><input type="hidden" name="_wp_http_referer" value="/awards-of-excellence-nominations-2/"><!-- [et_pb_line_break_holder] --> </form><!-- [et_pb_line_break_holder] --> </div> <!-- .et_pb_contact --><!-- [et_pb_line_break_holder] --> </div>