"Citizen of the Year" Nomination Form

Name of Nominee:

First Name:    Last Name:

Address: 

Street:

City:      State:       Zip:

Telephone:

            Day:          Evening:    

Sponsor:       
                      (full name of nominating resident or organization)

Telephone of Sponsor:

            Day:          Evening:    

Boards, Committee, Chairs, Projects,et cetera, that the nominee has been on:

Reasons for nomination: