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Englehart & District Chamber of Commerce
P.O.Box 171,
Englehart, Ontario
P0J 1H0

Nomination Form
 For 2014 Citizen Of The Year And Lifetime Achievement Award

I wish to nominate __________________________________ for the Citizen Of The Year.

Please give reasons and his/her contributions in 2014 to improve the quality of life for the people of Englehart and Area. Please note that groups or organizations who are doing their usual mandate are not eligible for this Award.

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	Additional material may be attached.

I wish to nominate ________________________________for the Lifetime Achievement Award.

Please give reasons and/ or comments:

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	Additional material may be attached.

Name of Nominator (please print) ___________________________________

Signature:_____________________________________

Mail nominations to:	Englehart & District Chamber of Commerce
			P.O.Box 171,
			Englehart, Ontario, P0J 1H0

Deadline for submission of name(s):      January 30, 2015