Greater Picayune Area Chamber of Commerce

Nomination Form

2008 CITIZEN OF THE YEAR

Nominee's Name:

Phone No.:

Place of Residence:

Place of Birth:

Marital Status:

Spouse's Name:

Children's Names:

Provide the following information about your nominee.  If extra space is needed, please continue on a separate sheet and attach to this form.  Deadline for accepting nominations is October 17, 2008 by 4 PM.  Deliver to the Chamber of Commerce at 201 Hwy 11 N, Picayune; Or mail to the Chamber at P.O. Box 448, Picayune, MS  39466; Or fax to the Chamber at 601-798-6984. Or email to chambercommerce1@bellsouth.net.

Career Information:

Education (Schools attended, degrees, honors received, special activities):

Religious Activities:

Honors and awards received:

Achievements and/or contributions made to the community:

Summarize the reasons why you believe your nominee should be selected for this award:

Nominator's name:                                                                                Phone No.: