Request edit access
MP Housefather's Sesquicentennial Medal Nomination Form
To celebrate Canada’s 150th anniversary since Confederation, MP Anthony Housefather is looking for 20 distinguished individuals to recognize for their service to Mount Royal. The winners will be presented with a special Canada 150 Sesquicentennial Pin consisting of the original copper which covered the roofs of Canada's Parliament buildings from 1918 to 1996.

Nominations will be open June 15th until July 20th and the successful candidates will be presented with their awards later on in the fall.

Your Name
Your answer
Your Email Address
Your answer
Your Phone Number
Your answer
Nominee's Name
Your answer
Nominee's Email Address
Your answer
Nominee's Phone Number
Your answer
Nominee's Address
Your answer
Please describe why your nominee should be recognized with a Sesquicentennial Constituent Award. Supporting documents such as links to articles or websites may be included
Your answer
How did you find out about this nomination form?
Submit
Never submit passwords through Google Forms.
This form was created inside of Young Liberals of Canada. Report Abuse - Terms of Service - Additional Terms