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2. Name of Nominator *
4. Phone Number of Nominator*
5. Email Address of Nominator*
7. Name of Nominee*
9. Phone Number of Nominee*
10. Email Address of Nominee*
12. Criteria for Community Supporter Nomination*

    To recognize residents for outstanding achievements or contributions that have improved the quality of life for others. These may include: Community Service, Citizenship, Acts of Heroism or Bravery, Volunteering, Years of contribution will be determining factor. In the selections below please select the category for your nominee.

    1. Community Service
    2. Citizenship
    3. Acts of Heroism

    1. Acts of Bravery
    2. Volunteering
14. Please select all that apply in regards to your Nominee.*

    1. Made a Significant Impact to the Town of Slave Lake
    2. Enhanced the Quality of Life for the Town of Slave Lake
    3. Enhanced the Image of the Community
    4. Is a Professional in their Field

    1. Is an Amateur in their Field
    2. Being recognized for a single action
    3. Being recognized for an achievement over a period of time
16. Please provide further details on why your nominee should be awarded this recognition? *
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18. 1. Receive an email copy of this form.
19. Email address

    This field is not part of the form submission.

20. Submit

* indicates a required field