NOMINEE’S VOLUNTEER ACTIVITIES

Please attach a statement that relates in 200 words or less, why you are nominating the above named individual for the Recreation Nova Scotia Provincial Volunteer Award. Please include the volunteer activities with which the individual has been involved as well as any accomplishments, past awards, and kinds of contributions. Supporting documents in the form of clippings or letters of support are also welcome.

REFERENCES

Please give the name and telephone number of someone who can be contacted as a reference for the nominee and who will be able to verify the scope and extent of the nominee’s volunteer contributions.

Reference Name:                                                                                                                          

Address:                                                                                                                                        

Telephone Number:                                                                                                                       

Nomination submitted

By:                                                                                                                                                 

Telephone Number:                                                                                                                       

Date:                                                                                                                                          

Please return this form by February 10^th, 2012 to:

                                    Volunteer Nominations

                                    ATTN: Trudy Payne, Director of Recreation Services

                                    Municipality of the District of Lunenburg

                                    210 Aberdeen Rd.

Bridgewater, NS   B4V 4G8     or email This e-mail address is being protected from spambots. You need JavaScript enabled to view it