Citizen of the Year

2016 Citizen of the Year Nomination Form

Entry Deadline: Jan 15th, 2017

The Mount Shasta Chamber of Commerce is seeking nominations for the 2016 Citizen of the Year Award. The Chamber Awards are the most prestigious and longest-standing awards given by a business organization in Mount Shasta.

Process: Please answer all questions, as completely as possible. The information provided will assist the Chamber Board of Directors in their decision process. Please do not nominate a Citizen who has previously won Citizen of the Year.

Nominee's Name*
Nominee's Business*
Nominee's Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Nominee's Telephone Number*
Citizen*
- Nominee has made significant contributions to the local community.
- Nominee is an individual resident of Mount Shasta or sphere of influence.
Describe this Person’s contribution, listing as many specifics as possible. How has this Person enhanced the quality of life in our town?*
Please state your personal reason for this nomination.*
Please provide your name and telephone number in the event that we have any questions.
Name of person nominating*
Telephone Number of Person Nominating
Date
MM slash DD slash YYYY
For more information call the Chamber office at (530) 926-3696 ext. 201

2016 Citizen of the Year Nomination Form

Entry Deadline: Jan 15th, 2017

Please provide your name and telephone number in the event that we have any questions.

For more information call the Chamber office at (530) 926-3696 ext. 201

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