Nomination Online

Please complete the information below and submit this form at least 1 week (5 business days) before the meeting. You can also send it by email to [email protected]

First Name (required)

Last Name (required)

Email (required)

Organization Name (required)

Organization Address (required)

Please include the organization's mission statement, populations served, how they would intend to use and any other pertinent information below:

Please list why you would want to nominate this organization or any experiences you have had with it that makes it special.

Organization Website (required)

Organization Email (required)

Is the organization a 501(c)3 non-profit? (required)YesNo

The organization agrees to not use, give, or sell the contact information of our members for additional solicitation by them or other organizations.If selected, organization agrees to sign and abide by the terms of the Charity Organization Donation Agreement.
Initial here:

Date (required)