Leavenworth-Lansing Area Chamber of Commerce
518 Shawnee, P.O. Box 44,  Leavenworth, Kansas 66048,  (913) 682-4112, FAX: 682-8170, E-mail
Representing the Communities of Lansing, Leavenworth and Fort Leavenworth.


Dan Wiley, President

Charlie H. Gregor, Jr., Executive Vice-President

Connie Hachenberg, CVB Director

Connie J. Winters, Office Manager

Citizen of the Year
Nomination Form and Cover Sheet

Rules:
1. The deadline for accepting nominations is: Friday, January 12th, 2007
2.  Nominations may be made by organizations or individuals.
3.  Selection will be made by a Chamber of Commerce committee.  The nominee selected will be announced at the Chamber of Commerce Annual Meeting & Banquet.
4.  All nominees must sign the nomination form and agree to attend the Chamber of Commerce’s Annual Meeting and Banquet on January 17th, 2007.

Personal Information
Name of Nominee: Phone:
Address:
Name of Spouse & Number of Children:
High School: Year Graduated:
Other Education:
Military Service Dates (if applicable): Branch: 
Military Rank: Honors:
   

 

Please attach a paragraph or more on each of the following areas.

Background:  Personal qualifications (include job positions with dates)
Organizations:  Positions - offices held with dates
Community Involvement & Projects:  Briefly list contributions to the Leavenworth-Lansing-Fort Leavenworth Community
Other Qualifications & Interests: Other factors to be considered in evaluating nominee
 

Nominator (& Organization, if applicable):
 		 Phone:

Nominee Statement: All facts included here are, to my knowledge, accurate and may be used for publication.  I will attend the Annual Meeting and Banquet on January 17th, 2007 and accept the Citizen of the Year Award if selected.

Nominee's Signature: Date:


Chamber Home Page


Revised: 10/30/06