ANDREW LIPTAK COMMUNITY SERVICE AWARD
(Sponsored by the Promote Welland Task Force)
This Award recognizes those who have contributed in an outstanding way to the social fabric of our community.
Name of Candidate:____________________________________________________________________
Name of the Business: __________________________________________________________________
Name of Nominating Company/Individual:____________________________________________________________________
Contact Person:________________________________________________________________________
Phone Number: _____________________________ Fax Number: _______________________________
Address: _______________________________________________________________________________
_______________________________________________________________________________________
Please answer the following questions:
1. Organizations involved in and dates of involvement?
2. Contribution made to the nominating organization?
3. Overall involvement in the community in 1997?
4. Approximately how may hours has the candidate worked as a volunteer in 1997?
5. What was the most important contribution made by the nominee in the past year?
6. Was participation solely voluntary or work related?
PLEASE ENSURE THAT THESE QUESTIONS ARE ANSWERED IN YOUR SUBMISSION, NOMINATIONS RECEIVED WITHOUT THIS IMPORTANT INFORMATION WILL NOT BE ELIGIBLE FOR THE AWARD.
Please return nominations to the:
Welland/Pelham Chamber of Commerce, 32 East Main Street, Welland, ON L3B 3W3
Telephone (905) 732-7515, fax (905) 732-7175 or 1. E-mail us: chamber@iaw.on.ca
Deadline for submitting nominations is January 14, 2000.