Gala - Citizen of the Year Nominee Nominee

First Name *

Last Name

Email *

Phone *

Nominee Name *

Nominee Business/Organization

Location of Business/Organization

Years in business

Is the Nominee aware of this nomination?

Yes

No

Is the nominee a member of the Brockville & District Chamber of Commerce?

Yes

No

Nominee Email

Nominee Phone *

Describe the nominee’s outstanding leadership and commitment to the Brockville & district community *

Give examples of the nominee’s outstanding citizenship. *

Illustrate the vision and civic pride demonstrated by the nominee. *

How does the nominee positively impact and contribute to the Brockville and district communities?

Any Additional Information