Rotary Unsung Hero Service Award Nomination

UNSUNG HERO SERVICE AWARD NOMINATION FORM
We are seeking nominations for our Unsung Hero Service Award. An unsung hero is someone who has made a positive and substantive contribution to his/her community or workplace, and yet does not seek recognition. This exemplifies Rotary’s motto “Service above Self”. Nominees are to be non-Rotarians, residents of North Bay or surrounding communities, and be 18 years of age or older.

Please submit this form by Septmber 21, 2024.
- Nominee's Name*
  
  First NameLast Name
- Nominee's Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip CodeCountry
- Nominee's Home Phone Number
  
  Area CodePhone Number
- Nominee's Cell Phone Number
  
  Area CodePhone Number
- Nominee's E-mail Address*
- Nominator's Name*
  
  First NameLast Name
- Nominator's E-mail Address*
- Nominator's Home Phone Number
  
  Area CodePhone Number
- Nominator's Cell Phone Number
  
  Area CodePhone Number
- Relationship to Nominee*
- Reason For Nomination*
  Please outline the key reasons for nominating this individual.
- PRIVACY DISCLAIMER: The Rotary Club of North Bay only collects personal information with the knowledge of the individual involved. We will explain what information is being collected and how it will be used. You have the right to decline to have this information collected or transferred. We will not disclose any personal information about users to any outside parties unless the user was advised of this possibility before providing the personal information. We will disclose information we maintain when required to do so by law. The above information will not be sold or rented for the purpose of solicitation to or by other companies or agencies.
- - Click on Print Form if you wish to download/print a copy for your records.
  - Click Save to save as a draft to complete or edit before submitting.
  - Please click Send Nomination to submit your form.
- Should be Empty:

UNSUNG HERO SERVICE AWARD NOMINATION FORM