Citizens Communications : Featured Wireless Customer

COMMUNITY

Nomination Form

c3bb Communications Corporation Broadband Wireless

Scottsburg's Mayor - Good Neighbor of the Year Award Nomination Form:

I would like to nominate the following as the 2012 Good Neighbor of the Year. Fill out the form below and your nomination will be processes via online OR download the nomination form by clicking here and mail in your nomination.

NOMINATIONS ARE DUE BY MAY 11, 2012

Name: *
Address: *
Phone Number: *
Please check one category: *	Business Church/School/Civic/Other (Youth Group - Age 18 & Under) Church/School/Civic/Other (Adult Group - Age Over 18) Individual - (Youth - Age 18 & Under) Individual (Adult - Age Over 18) Industry
Name of person nominating: *

Address of person nominating: *
Phone of person nominating: *
E-mail Address: *
Please list accomplishments & activities from that should be considered for nomination. Please describe in as much detail as possible. All nominations are subject to review by the Committee. Past recipients of the Individual Good Neighbor Award are not considered for re-nomination. *

Attach file of accomplishments & activities:


* Required