Roger Marple Volunteer Award
2023 Nomination Form
Name of volunteer being nominated:
First Name
Last Name
Email:
example@example.com
Organization of volunteer being nominated (if applicable):
Phone Number:
City/Town and Province:
Preferred method of contact:
Preferred method of contact:
Email
Phone
Name of person nominating the volunteer:
First Name
Last Name
Organization of person nominating volunteer (if applicable):
Phone Number:
Email:
example@example.com
City/town and Province:
Preferred method of contact:
Preferred method of contact:
Email
Phone
(Not a requirement) Is the nominee affiliated with the Alzheimer Society of Alberta and Northwest Territories? If yes, please describe below:
Please input your application for nomination below:
Relevant attachments in support of the nomination:
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Thank you for your nomination!
All nominees will be notified of the outcome in December, and all nominees are encouraged to attend the Annual General Meeting in January where the winning nominee will be announced.
Submit
Should be Empty: