Individual Rotarian Award Nomination Form

Individual Rotarian Nomination Form

Deadline midnight on June 30th, 2026
Use this form to nominate an individual for a specific District 5810 Award. Use a separate form for each individual award. Include two pictures with your nomination form – one of the nominee and one of them in service/action during a project.
Name of Nominee

First NameLast Name
Name of Nominee's Club
Name of Individual Award
Rotarian Making Nomination

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Nominator's Club
Explain Why This Individual Should Receive This Honor
Photo Upload

Photos
Cancelof
Should be Empty:

Individual Rotarian Nomination Form