100 Written Words nomination form
The Wyoming Jaycees will mail 100 anonymous empowering messages to 100 different people in the next 100 days. Please use this form to submit your nomination to receive a message. Your information will be confidential and is only being gathered in case there are any questions about your nomination. Nominations must be received by December 30th, 2021 and we will complete all 100 deliveries on or before December 31st, 2021.

Selected nominations are at the sole discretion of the Wyoming Jaycees. Our goal is to make a positive impact on people's lives by sharing a tiny piece of joy. Any nominations deemed inappropriate or offensive will be rejected.

If you are between the ages of 18-40, you should consider joining the Jaycees so you can grow your leadership skills and make a positive impact in your community! Find out more here: www.jciusa.org or www.jayceemember.com 

You can also follow us on Facebook at www.facebook.com/wyjaycees
Sign in to Google to save your progress. Learn more
Your name and phone number (will be kept confidential) *
Recipient's first and last name *
Recipient's address *
Tell us a little bit about the recipient and why they could use a little encouragement (ex. a teacher dealing with COVID issues, a single parent struggling to stay afloat, a senior who is lonely, etc.) *
Optional: would you like us to write a personalized message in the card? Your name will not be shared. (ex. thank you for making an impact on my life; you have a pretty smile; etc.)
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms