Fort McMurray Chamber of Commerce COMMUNITY AWARD NOMINATION FORM: Instructions

The Fort McMurray Chamber of Commerce Award Program celebrates the potential of all as valued members and leaders of the community and recognizes those who support them. The Fort McMurray Chamber of Commerce Award honors individuals who strive toward the highest levels of professional accomplishment… who excel in their chosen field, have devoted time and energy to their community in a meaningful way, and who also open paths so that others may follow.

THE CRITERIA Recipients must meet the specific criteria. They must:

Provide valuable service by devoting time and energy to improving the quality of life for others in the community

COMPLETING THE FORM Nominations for the Fort McMurray Chamber of Commerce Award must be submitted using this nomination form (or a photocopy). Form must be typed or printed clearly.

One additional sheet may be added to this form, and a resume or Curriculum Vitae should be submitted. Nominators may find it helpful to seek the input of the Nominee to complete the nomination form. Please review the nomination form carefully to ensure that comprehensive, quantitative information is supplied which demonstrates the involvement & achievement, of your nominee. The more complete the information provided, the more useful this form will be for those who judge this important award.

THE PROCESS A Selection Committee of prominent community leaders will review all nomination forms and select the Fort

McMurray Chamber of Commerce Award recipient.

NOTE: Members of the Fort McMurray Chamber of Commerce Board of Directors, Staff and as well as Sponsors and Judges are ineligible to be nominators or nominees for the Fort McMurray Chamber of Commerce Award. RETURN COMPLETED Fort McMurray Chamber of Commerce FORM TO: ATTN: Award Committee 304, 9612 Franklin Avenue Fort McMurray, AB T9H 2J9 Telephone: 780-743-3100 Fax: 780-790-9757

SUBMISSION DEADLINE: 5:00 p.m. – September 12th of each nomination year

COMMUNITY AWARD NOMINATION FORM

Please refer to the Nomination Guide when completing this form. The nominee must be informed of your intention to put their name/business forward. Please ensure the nominee reviews this form and its contents. PLEASE PRINT IN INK OR TYPE. This form is confidential once submitted.

Please check appropriate award: “Leader of Tomorrow Award” “Sustainable Community Recognition Award”

“X-ceptional Kidz Award” – Age Category: _____ _____

9-13 14-17

NOMINEE INFORMATION

Name: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

Name of Business/Organization: __ __ __ __ __ __ __ __ __ __ __ __ Position: __ __ __ __ __ __ __ __ __ __ __ __ __

Address: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Postal Code: __ __ __ - __ __ __

Home Phone: __ __ __ - __ __ __ - __ __ __ __ Fax: __ __ __ - __ __ __ - __ __ __ __

Email: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

PARENT/LEGAL GUARDIAN INFORMATION (only applicable if Nominee is under legal age [Xceptional Kidz Awards)

Parent/Legal Guardian Name: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _

Age of Nominee: __ __ (at time of nomination) Relationship to Nominee: __ __ __ __ __ __ __ __ __ __ __ __ __

NOMINATION SUBMITTED BY

Name: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

Name of Business/Organization: __ __ __ __ __ __ __ __ __ __ __ __ Position: __ __ __ __ __ __ __ __ __ __ __ __ __

Address: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Postal Code: __ __ __ - __ __ __

Phone: __ __ __ - __ __ __ - __ __ __ __ Fax: __ __ __ - __ __ __ - __ __ __ __

Email: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

AUTHORIZATION

We confirm the information contained in this nomination is correct and accurate. I consent to releasing this information to the Fort McMurray Chamber of Commerce and to the selection committee and to having my name, summary of achievements, and photograph published and released to the media and in Fort McMurray Chamber of Commerce publications. Nominee Signature _______________________________________________________________________________

Date _____________________________ Nominator Signature _______________________________________________________________________________ The nominee/Parent or Legal Guardian is aware of and supports this submission. I also consent to having my name/child’s name, summary of achievements, and photograph published and released to the media and in Fort McMurray Chamber of Commerce publications. Parent or Legal Guardian Signature _____________________________________________________________________

Please Print Name _________________________________________________________________________________ Date _____________________________

This information is subject to the disclosure provisions described in the Freedom of Information and Protection Act.

Inquiries: 780-743-3100 Mail to: #304, 9612 Franklin Avenue, Fort McMurray, AB T9H 2J9

Or Fax to: 780-790-9757

IN YOUR OWN WORDS...

Using the selection criteria, please describe the key reasons for making this nomination and provide specific examples. Submissions MUST be typed and not exceed two (2) 8 1/2 x11 pages single-sided. Please remember to include two (2)

letters of support and photos if available,.