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Nomination Category

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Nominee Contact Information

Nominee Name

Address

City

State

Zip

Daytime Phone

E-Mail

Description of Nominee

A typed, detailed description, no more than 1 page in length, of the nominee’s activities that have prompted you to make this nomination. Please address the eligibility criteria for the category for which the person or organization is being nominated.

Description

Nominator Contact Information

Your Name

Address

City

State

Zip

Cell Phone

E-Mail

Signature (Type your full name)

Photographs taken at the event may be used for promotional/marketing purposes of Interfaith Caregivers of Washington Co., on our website, in printed materials, or in any other way deemed appropriate by Interfaith. If you or the person or organization you are nominating do not consent to the use of photographs, please check the box below.


If you have any questions, please call Janean Brudvig at 262-365-0902