Giveaway Rules and Affidavit of Eligibility
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Nominator Information
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Relationship to Nominee
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How did you hear about Nominate a Neighbour?
Nominee Information
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Address
Street Address
Street Address Line 2
City
Postal / Zip Code
Organization Name (if applicable)
Please describe the plumbing issue?
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Please explain why should this person be considered for the Mr. Rooter Edmonton Nominate a Neighbour program?
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Is the nominee aware that you are nominating them for the program
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Yes
No
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Yes
No
Submit
Should be Empty: