Consent Form

(To be submitted with all application forms)

Please call the Regina Chamber office at (306) 757-4658 if you have any questions about this form.

APPLICANT INFORMATION

Business Name:______

Contact Name:______

Address:______

______Postal Code:______

Phone #: ______Fax #: ______Email:______

Number of Employees: Full-time/Equivalent: ______Part-time: ______

In Operation Since:______

RULES OF ELIGIBILITY

Open to all businesses with the exception of Crown Corporations and/or government bodies in the city of Regina and immediate surrounding area.

Nominees must provide services or conduct business within Regina.

Members and non-members of the Regina & District Chamber of Commerce are eligible for an award.

A separate entry and consent form is required for each award category.

Past award winners must wait two years to reapply for a Paragon Award in the category in which they received the award(s). (Award winners are welcome to apply for other award categories any time.)

You may apply for ONE category & The Business of the Year

A standardized application process has been developed. Only application forms that follow the established criteria will be accepted.

No requests will be made to review financial records. However, applicants may be asked to provide a letter of assurance from its accountant or bank manager.

All entries are confidential.

Judging will be conducted by an independent, anonymous panel selected by the Paragon Committee with final tabulation being conducted by MNP.

Application deadline –February 1, 2017.

GENERAL INFORMATION

The Paragon Awards Selection Committee will consist of ten (10) independent judges who shall remain anonymous. The results of the Judging Body will be tabulated by Meyers Norris Penny and sealed until the actual Paragon Awards event. Neither the Judging Body nor the Paragon Awards Committee will be privy to the results until they are announced.

All information provided will be strictly confidential and will be reviewed only by the Paragon Awards Selection Committee.

This form MUST accompany each application. Please use the space provided only; attachments will not be reviewed.

Note: Small, medium and large businesses are treated equally in the judging process.

CONSENT

I hereby consent to have my application considered for the Regina & District Chamber of Commerce Paragon Awards. I have read and comply with the rules of eligibility.

Applicant Name: ______

NameDate

All information provided shall be kept in strict confidence.