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
Lindsey Aytes, Office Manager
Citizen of the Year
Nomination Form and Cover Sheet
Rules:
1. The deadline for accepting nominations is: Friday, January 9th, 2004
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 21st, 2004.
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 21st, 2004 and accept the Citizen of the Year Award if selected.
| Nominee's Signature: | Date: |
Revised:
06/08/05