Refer to the instructions that accompany this nomination form. All information on and included with this form is considered a public record and may be released to others upon request. All materials submitted with this nomination form will be retained by the Town of Cary. Please type or print to ensure legibility.

Nominee’s Name: __________________________________________________________

Nominee’s Address: __________________________________________________________

(include complete street mailing address with town and zip code)

Nominee’s E-mail Address: ___________________________________________________

Nominee’s Phone Number: ___________________________________________________

Is the nominee 21 years of age or older? Yes No

(Minimum award eligibility age is 21)

Nominee must be nominated by two individuals.

Summarize in 500 words or less (either below or on a separate attachment) why you believe this person should receive the Hometown Spirit Award. Comment specifically on all of the applicable criteria (both general and specific as listed on the instruction sheet). Please do not include any additional materials as attachments.

_____________________________________________________________________________

Submit the completed application as instructed below (by e-mail, fax or mail). To be eligible for consideration, the town clerk must receive the completed nomination form by 5 p.m. on October 9, 2009.

Sue Rowland, Cary Town Clerk
E-Mail: sue.rowland@townofcary.org; or
Fax: (919) 460-4910; or
Mail: Sue Rowland, Town Clerk
Town of Cary
P.O. Box 8005
Cary, NC 27512-8005

Questions? Contact Sue Rowland, Town Clerk, at sue.rowland@townofcary.org or (919) 460-4941.