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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 Distinguished Achievement Category
    To recognize residents whose actions have had a profound or extraordinary impact either provincially, nationally or internationally.
14. Please select all that apply *

    1. Made a significant impact to the Town of Slave Lake
    2. Enhanced to Quality of Life for the Town of Slave Lake
    3. Enhanced the image of the community
    4. Are a professional in their field

    1. Are 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

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