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Certificate of Appreciation Application/Nomination Form
Please submit nominations and suggestions by March 31st to:
Chair, SMLD Nominating Committee
c/o SMLD Office
5 Monument Square
Portland, Maine 04101
Name of Nominee (Mr/Mrs/Miss) ________________________________________
Mailing Address _____________________________________________________
City, State, Zip _____________________________________________________
Home Phone ___________________________________
Business Phone ________________________________
Title ______________________________________________________________
Organization or Firm _________________________________________________
Nominated By ______________________________________________________
Daytime Phone _________________________________
E-Mail ____________________________________________________________
Mailing Address _____________________________________________________
City, State, Zip _____________________________________________________
Nominee's Major Contributions _________________________________________
__________________________________________________________________
__________________________________________________________________
Signature _________________________________________________________
Date _________________________________________
Please attach supporting documentation and resume regarding qualifications.
Thank you!