Citizen of the Year - created by phpFormGenerator

Citizen of the Year

Citizen of the Year Nomination Form.

Date of Report: * Please use the calendar provided to enter the date of the report.
Lodge: * Please select your Lodge.
Lodge Committee Chairperson: * Please enter the first and last name (in that order) of your Lodge's Chairperson.
Lodge Committee Chairperson E-mail Address: * Please enter the e-mail address where you would like your copy of this report sent. This can be your Lodges or your personal email address.
Name of Candidate: * Please enter the name of the candidate as first and last name in that order. The candidate can be either an Elk or a Non-Elk.
Reason for Selection: * Please provide the reasons for your selection - be specific.

Type the following: For security purposes, please type the letters in the image.