Citizen of the Year Nominee’s Questionnaire

Citizen of the Year recognizes an individual who has made outstanding contributions to the business community and the community at large. This person gives freely of their time, talent, energy, and expertise. This person must live or work in Mason County. Contributions considered must be made by this individual outside the scope of regular business or duties performed through employment. The most recent award went to Justin Baze; a list of all the past recipients can be found here.

Please complete the form below on or before Sunday, November 19, to be considered for this year’s award. All nominations received by that date will be reviewed by the selection committee. The committee will recommend just three nominees from each category to go on the ballot. Once the Chamber Board receives and approves the finalists, the membership at large will be invited to vote.

Name *

First

Last

Business/Organization Affiliation

Email *

Address

Address Line 1

Address Line 2

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Phone *

• Please tell us about yourself and your greatest accomplishments.

Describe your connection to Mason County and how you have engaged in the community.

What did you do this past year that makes you most proud?

What are you most passionate aboute?

Who is/was your mentor and why?

Please list any awards/honors you have earned.

Please provide any other information that you feel the selection committee should review while considering your nomination.

Submit