ROTARY CLUB OF EDEN PRAIRIE (AM)

Volunteer of the Year
Nomination Form

To recognize "Service Above Self," the motto of Rotary, the ROTARY CLUB OF EDEN PRAIRIE (AM) wishes to honor a member of the community who lives this motto by volunteering in the community. The individual selected will not be a Rotary member, will be active in a variety of ways in the community, have an interest in raising the quality of life for all community members and demonstrate dedication by sustained service to Eden Prairie and/or the greater community.

Mail application to Eden Prairie AM Rotary Club, P.O. Box 44603, Eden Prairie, MN 55344. Or apply online by submitting this form. Submission deadline is April 8, 2005. Contact Jan Eian at 952-294-2704 or jeian@endurant.com with questions.
NOMINEE INFORMATION:

Nominee
Street
City, State ZIP
Phone
E-mail
Age Category Under 21     Over 21



Activity - Briefly describe the nominee's exemplary service.




Accomplishment - What were the benefits of the nominee's efforts?




Affect - Every volunteer is worthy of recognition. What makes the accomplishments of this nominee more significant than that of others?




References

Name 1 Phone
Name 2 Phone



Your Name
Your E-mail
Date


I acknowledge that the information contained in this nomination is an accurate representation of the service performed by the nominee.