Required Fields
Name
Address
City
Province
Postal Code
Phone Number - -
Fax Number - -
Email Address
Date of Birth (MM/DD/YYYY) - -
How did you hear about this award?
What is the name of your local paper?
What is your relationship to the nominee?
(Nominations should be 750 words or less and should make clear the contribution made by the individual to the community).
Group Name
Group Contact Person
Contact Phone Number - -
(Please describe the organization selected by the nominee as the potential recipient of a $5,000 donation. Descriptions should be 250 words or less and should clearly identify services the organization provides to the community. The nomination must also specify how the designated group would make use of the $5,000 donation.)
I/we have read the Volunteer Citizen of the Year Award Rules and know of no reason why I/we would not be eligible to receive this award. I/we agree to follow the rules of this competition and to abide by the decisions of the award review panel.
I/we release and discharge Direct Energy Marketing Limited, Alberta Weekly Newspapers Association and their respective directors, officers, employees and agents (the “Released Parties”) from all claims arising from participating in or winning this contest.
I/we grant the Released Parties the right to photograph and/or videotape me/us and further to use my/our name(s), face(s), likeness(es), voice(s), hometown(s), information contained in this nomination and any other information I/we voluntarily provide, for use by Direct Energy Marketing Limited and/or the Alberta Weekly Newspapers Association in connection with exhibitions, publicity, advertising and promotional materials, without reservation, limitation or further compensation. The Released Parties, however, are under no obligation to exercise such rights.
Yes I have read and agree to the Statements above:
