Community Excellence Nominee

Fill out the form below to nominate an Individual, Business or Organization for the 2022 Awards of Excellence Gala - Community Excellence Award.

First Name*

Last Name*

Email Address*

Phone*

Name of Nominee*

Describe the nominee’s contributions to the quality of life in Brockville and district communities*

Give examples of the nominee’s volunteer work and financial contributions to our community.*

Illustrate how the nominee develops community partnerships and supports the not-for-profit/charitable sector in our community.*

How does the nominee positively impact and contribute to the Brockville and district communities?*

Additional Information

Is Nominee aware of this nomination?*

Location of organization

Is nominee aware of the nomination?

Is the nominee a member of the Brockville & District Chamber of Commerce?

Nomination Submitted By

contact information for nominator*

Contact information for nominee*