Celebrating Community Leadership across BC

Do you know a volunteer who’s doing outstanding work in our community? Nominate them and they could make a $1,000 donation to a local charitable organization, courtesy of Island Savings, a division of .

Completed applications can be submitted: • By email: [email protected] • By mail: Attn: Stephanie Perryman, First West Credit Union, 200 - 19933 88th Ave, Langley, BC V2Y 4K5

There’s two ways to complete this nomination form: 1) Answer the following questions in an email and send along with a completed and signed copy of Page 2. 2) Use the space below to answer the questions, sign and send to us by email or mail.

• Please attach a high-resolution photo of the nominee (1-2MB at 300dpi) participating in volunteer activities with the organization.

1. Please provide your Nominee’s name and contact details (phone, email) 2. Please provide the name and address of the organization this nominee volunteers for. 3. How long has this nominee been volunteering with this organization? 4. How does this nominee spread Simple Generosity in our community? 5. Why is this nominee an exceptional volunteer? Describe the ways the organization and community benefits from his/her volunteer contributions.

Thank you for inspiring us! We appreciate the outstanding contributions by all volunteers.

#SimpleGenerosity is a community initiative of:

Please review and acknowledge your consent to the following:

I authorize First West Credit Union to use the information and images provided to profile this

nominee and the organization on the First West websites and social media channels, should my

nomination be successful.

I have notified the nominee that they have been nominated for this award.

The legal stuff: • Donations are not payable to an individual. • Individuals who are nominated and selected for a volunteer award, will be required to designate their award to a charitable organization of their choice. • Nominated volunteers and the non-profit or charitable organizations must be located in a community where Island Savings operates; Greater Victoria, Cowichan Valley, Ladysmith, Salt Spring and Pender Island and . • Non-profit or charitable organizations must be registered with the CRA or registered with the BC Societies Act. • By submitting this Nomination Form, the Applicant gives First West Credit Union and its divisions (including , Enderby & District Financial, Island Savings and ) the right and permission to publish his/her name and details of this Nomination as captured for the #SimpleGenerosity campaign. • If your Nominee is selected as a winner, you will be contacted by a member of our Community Investment team. • The Nominee will be required to give consent for the use of his/her likeness and image for promotional purposes. If the Nominee is not able to grant consent, the award will be designated to a charity of First West Credit Union’s choice.

If this Nomination is successful, the Applicant acknowledges and agrees to the following: • If possible, to join First West Credit Union and its divisions at a cheque presentation to the selected non-profit organization. • First West Credit Union is entitled to all rights of ownership in connection with the use of my image and I waive all rights I have related to that image. • Any photographs or video recordings of me may be edited, altered, copied, published, republished or distributed to third parties, now and in the future, worldwide via DVDs, the internet or other public setting. I waive any right I may have to inspect or approve the finished product where my image or likeness appears. • I waive any right to receive royalties or other compensation arising from or related to the use of my image. • First West Credit Union may use my name for any purpose in connection with the use of my image, including on printed material, video, streaming media or broadcast.

By signing this form, I acknowledge that I have completely read and fully understand this release and agree to be bound by its terms and conditions.

Nominator information Your name / contact details (phone, email, address)

Nominee Signature

Date nomination submitted:

Due to the large volume of submissions, only those selected will be contacted.

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