Breakfast Nomination Form

At the North County Incorporated Annual Breakfast on Friday, May 10, 2019 we will present awards to those individuals who have shown a strong commitment to the North St. Louis County region through their business, civic and/or humanitarian acts. We need your help to identify these key individuals, businesses or other organizations. Please complete and return the following information:

Awards will be presented in five categories:

Business Development Award: An individual, organization or business whose efforts positively impacted the economic development and business climate of the North St. Louis County area.

Community Development Award: An individual, organization or business whose efforts positively benefited youth, residents, civic organizations or others through selfless acts. Their contribution needs are beyond the individual’s employment responsibilities or a business/organization’s mission and scope of work.

Elmer Belsha Leadership Award: An individual whose long-term commitment to North County Incorporated and the North St. Louis County area has had a positive impact.

Diversity and Inclusion Award: recognizes individuals or organization showcasing exemplary dedication to diversity and equity initiatives while promoting a culture of inclusion.

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.

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 15, 2019. 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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North County Incorporated

350B Village Square Drive
Hazelwood, Missouri 63042
phone: (314) 895-6241
email: nci@northcountyinc.com

 

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