Submission Form for 2023

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Instructions

There are 3 sections to the Submission Form:
1. A Nominee Section - Where you will tell us about who you are nominating.
2. A Contribution Section - Where you will describe the impact the Nominee is having in the community. PLEASE NOTE: You can develop the narrative and ‘paste’ it into this section or key it directly into the Submission Form.
3. A Nominator Section - Where you will tell us about yourself.

This information will not be used by anyone except the Rotary Club of Evansville.

NOTE: You will need to complete and submit this form in one session.

Nominee Information

First Name *

Last Name *

Age *

Location? *

Nominee's Personal Phone Number *

Nominee's Personal Email Address *

Nominee's Job Title *

Nominee's Company *

Nominee's Work Phone *

Nominee's Work Email *

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