Breakfast Nomination Form

At the North County Incorporated Annual Breakfast we will present awards to those individuals who have shown a strong commitment to the North County region through their business, civic, and/or humanitarian acts. We need your help in identifying these key individuals, businesses or other organizations.
Awards will be presented in four categories:
Business Development: An individual, organization, or business whose efforts positively impacted the economic development and business climate of the North County area.
Community Development: An individual, organization, or business whose efforts positively benefited youth, residents, civic organizations, or others through selfless acts. Their contribution needs to be beyond the individual’s employment responsibilities, or a business/organization’s mission and scope of work.
Public Service Award: An outstanding individual elected, appointed, or employed by a public body whose long time service has had a positive impact on the community and/or public body they serve.
Elmer Belsha Leadership Award: An individual whose long-term commitment to North County Incorporated and the North County area has had a positive impact.
NOTE: The individual nominated must reside, own, or work for a business, organization, or institution located or working within the North St. Louis County region. Entries must be at least 18 years of age, and nominations must be submitted no later than Friday, March 24. Incomplete applications will not be considered.
Please complete and submit the following information:
NOMINATION FORM
PLEASE FILL OUT THE FOLLOWING INFORMATION ABOUT YOURSELF:
NAME*:

EMAIL*:

PHONE*:

ADDRESS*:
CITY*:
STATE*:
ZIP CODE*:

PLEASE FILL OUT THE FOLLOWING INFORMATION ABOUT THE PERSON YOU ARE NOMINATING:
NAME*:
CATEGORY SELECTION:

EMAIL:

PHONE:

ADDRESS*:
CITY*:
STATE*:
ZIP CODE*:

DESCRIPTION OF NOMINEE'S CONTRIBUTION TO SELECTED CATEGORY
Please send bio and any necessary attachments to nci@northcountinc.com
:


Please copy the code below:
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PRINTABLE NOMINATION FORM

 

 

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