Community Champion Nomination Form
Tell me a bit about a your local Community Champion! This form takes about 5 minutes to complete. Questions? Contact ron.mckinnon.c1@parl.gc.ca or 604-927-1080
Nominator Information
Person making the nomination. Self nominations are OK.
Name (nominator) *
Your answer
Address (nominator) *
Your answer
Phone Number (nominator) *
Your answer
Email (nominator) *
Your answer
Is the nominee aware that you are making this nomination? *
NOMINEE INFORMATION
Nominee: Community Champion.
Name (nominee) *
Your answer
Address (nominee) *
Your answer
Phone Number (nominee) *
Your answer
Email (nominee)
Your answer
Why do you think she or he is Community Champion? Provide some details about his or her work in our community. *
Your answer
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