Gala Mëmë-Honor mention

NOMINATION - MËMËGWASHI HONOURABLE MENTION

* Indicates mandatory field

* Indique un champ obligatoire

Full name of nominee *

Prénom

Nom

Adress *

Ligne 1

Ligne 2

Ville

État

Code postal

Pays

Phone number *

School attended *

Email address *

Age *

Name of the person registering the candidate *

How has the nominee demonstrated perseverance? *

In what ways is the nominee engaged in the community? *

Describe how the nominee has distinguished themselves through academic or life experiences, commitments, or accomplishments. *

Why do you believe this individual deserves the Mëmëgwashi Honorable Mention? *

Please provide any additional information that supports this nomination: *

Information - Registration
Anabelle Carbonneau
819-825-8299 extension 236

Soumettre