The Person You Are Nominating for the Civic Award Should Be Someone Who Has

CIVIC AWARD

NOMINATION FORM

The person you are nominating for the Civic Award should be someone who has:

(a)  made a material contribution to the welfare of the people of Warminster in the form of community service, efforts in support of charitable work in the town, personal effort and achievement, or any form of personal self-sacrifice that has directly or indirectly assisted the townspeople of Warminster;

(b)  contributed to the advancement and wellbeing of the town of Warminster; or

(c)  performed any other act of outstanding citizenship.

Please note that all nominations will be treated as confidential and the nominee should not be aware that they have been nominated. This form should be returned to the Town Clerk at the address overleaf by Friday 28th August.

I (name of proposer) ………………………………………………………………………………………......

of (address of proposer)………………..…………………………………………………………......

…………………………………………………………………………………………………………………………………………………………

HEREBY NOMINATE

Name…..……………………….……………………………………….…………………………………………………………………………

Address………………………………………………………………………………….…………………………………………………………

……………………………………………………………………………………………….…………………………………………………………

to receive a Civic Award certificate for his/her services to the community of Warminster.

Please list here the reasons why you believe this person should receive a Civic Award:

(continued overleaf)

I certify that the details given are correct, that I have not been influenced or canvassed in any way and that the person nominated has no knowledge of the nomination. I understand that all matters relating to the nomination are confidential.

Proposer’s signature…………………………………………………………………………….…………………………………………………

Return this form by 28th August 2015 to:

The Town Clerk

Warminster Town Council

Warminster Civic Centre

Sambourne Road

Warminster

Wiltshire BA12 8LB

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