Giveaway Rules and Affidavit of Eligibility
*
Nominator Information
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Relationship to Nominee
*
How did you hear about Nominate a Neighbour?
Nominee Information
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Address
Street Address
Street Address Line 2
City
Postal / Zip Code
Organization Name (if applicable)
Please describe the plumbing issue?
*
Please explain why should this person be considered for the Mr. Rooter Edmonton Nominate a Neighbour program?
*
Is the nominee aware that you are nominating them for the program
*
YES
NO
Are we able to contact you to discuss your nomination further?
*
Yes
No
Submit
Should be Empty: