Your Name:

Your Contact Info (Email or Phone Number):

Is Your Nominee 70+?:

Is Your Nominee Male or Female:

Name of Nominee:

Please indicate the best method of communication for your nominee so we may share the good news with them! (this could be a phone number, email, or mailing address):

Tell us how your nominee has contributed to the Brigden Fair. (Will be read at the contest. Please write
in third person):

Where Did You Hear About the Competition?:

NOTE: Additional information you feel to be of interest may be written on a separate sheet of paper and
attached to this page.