2017 Awards of Excellence – Submission Form

* all fields are required.

Primary Nominator Name:
Primary Nominator CLPNBC Registration Number:
Primary Nominator Email:
Primary Nominator Address:
Nominee Name:
Nominee CLPNBC Registration Number:
Note, if not applicable, please indicate N/A above.
Nominee Address:
Nominee Email:
Which Award are you nominating for?
In 300-500 words or less, please provide a brief introduction of the nominee:
Nominee Declaration Form
Nominee Photo
*At least three letters are required
Guidelines for letters of support

Letters of Support:

Attach File #1:
Attach File #2:
Attach File #3:
Attach File #4:
Attach File #5:
Please attach all necessary files before hitting the Submit button
(valid files to upload include: PDF, DOC, DOCX, GIF, JPG, JPEG, PNG, RTF, TXT, XLS, XLSX)