PITCH-IN CANADA
Clean World Award Nomination Form

Information Required on Nomination Form

• Nominator's Name
  Organization (if applicable)
  Address
  City
  Province/postal code
  Tel/Fax/E-mail
   
• Nomination in which category?
  Individual
  Non-government Organization (ie: Scouts, Guides, 4-H etc...)
  Government Organization
  Educational Institution
  Media
  Industry and Business (ie: Chamber of Commerce, individual business, etc...)
   
• Name of Nominee
  Contact Name (if Nominee is not an individual)
  Address
  City
  Province/postal code
  Tel/Fax/E-mail

List achievements in support of PITCH-IN CANADA's Objectives (please ensure that your nomination documents sustained involvement)

Background Documentation (newspaper clippings, photos, printed materials, etc...)

Letters of Support (from others who can support your Nomination)

Send to

PITCH-IN CANADA
Clean World Award

at this address