Community Awards Nomination Form

Nomination Form for Annual Community Awards
“Mountain Utopia…Imagine the Possibilities”

Make plans to attend an evening at the SteamPlant Event Center
Friday, January 27th, 2017

It is that time of the year again, to show your appreciation to someone you believe makes a big difference in this community. Please take a moment to nominate a deserving person for Man and/or Woman of the year, From the Heart Award (This award is given to recognize a citizen’s generosity of spirit and volunteerism.) The Cornerstone Award (This award is given as recognition of long-term community support and dedication.)

Nomination forms must be submitted to the Chamber by 5:00 p.m., December 15, 2016
~ Nominations will be accepted from anyone in the community ~

PLEASE CIRCLE ONE OF THE FOLLOWING CATEGORIES:

Man of the Year                Woman of the Year                From the Heart Award                The Cornerstone Award

 

Name of Nominee: __________________________________________Phone: ______________

Address:_______________________________________________________________________________________________________________________________________________________

Name of Spouse: _________________________________________________________________

Children’s Names:________________________________________________________________________________________________________________________________________________________

Occupation: ______________________________________________________________________________________________________________________________________________________________

Career History: ______________________________________________________________________________________________________________________________________________________________

Contributions & Accomplishments to the Community: ______________________________________________________________________________________________________________________________________________________________

Organizations Nominee is involved with (professional, business, civic): ______________________________________________________________________________________________________________________________________________________________
Why do you believe this person is qualified for this award? _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Names of friends and/or relatives who could supply more information, if necessary: ______________________________________________________________________________________________________________________________________________________________

Nominated by (your name): ___________________________________Phone:______________

Please mail, fax, scan/email or drop by the Chamber prior to 5 pm on December 15, 2016

Salida Chamber of Commerce
406 W. Hwy. 50 ~ Salida, CO 81201 ~ (719) 539-2068
Fax: (719) 539-7844