Making a Difference. 367 Woodlawn Road West Guelph, Ontario, N1H 7K9

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Making a difference. 367 Woodlawn Road West Guelph, Ontario, N1H 7K9 www.guelphmercury.com Making a difference. Nomination Form Name of individual, company or community organization responsible for nomination: Name: Address: City: Postal Code: Do you know of someone The Guelph Mercury Tribune will accept Email: submissions for possible candidates for this Phone (day): Phone (evening): under the age of 40 distinction until February 12th, 2018. Self-submitted Primary Contact Person: applications are accepted. All selections will be Title: making a difference? made within the Guelph Mercury Tribune marketing Relationship to Nominee: & editorial departments. The final 20 will be Help us identify 20 people Nominee Information: profiled in a special publication distributed across Name: Guelph and area on March 15th, 2018 to recognize who live, work, study or Address: and celebrate these 20 outstanding citizens. play in our area. Nominate City: Postal Code: Email: SUBMISSION DEADLINE: Monday, February 12th at 5pm them for recognition in Phone (day): Phone (evening): Date of Birth (d/m/y): our special 20 under 40 TO SUBMIT A NOMINATION: Required Documentation: publication and tell us why Email: [email protected] Mail to: 1. Brief description (maximum 500 words) of the nominee’s contributions and achievements. they merit a place on this Guelph Mercury Tribune 2. Brief description as to why this person stands out and how Attention Rachel Chivers they’ve made a difference in your community. 3. A minimum of two letters of support from individuals other special honour roll. 367 Woodlawn Road West than family members. Guelph, Ontario, N1H 7K9 4. Copies of other supporting documentation you deem appropriate including pictures, awards, etc. Signature of the nominee accepting the nomination Signature of the nominator Date For more information: www.guelphmercury.com/awards.

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