Excelsior Nomination Form

Additional comments and supporting documentation may be included on supplemental pages, if
necessary. You may reproduce this form. In order to be considered for judging, form must be legible.
Nomination Forms are due Friday, November 11th at 5PM.
Completed forms can be mailed or delivered to:
Publisher's Office. Rockford Register Star, 99 E. State St., Rockford, IL 61104.
Please contact Bea Ricotta with any questions at bricotta@rrstar.com or 815.987.1453.

I would like to nominate
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code
President or Executive Director
Vice President or Executive Director
Organization Philosophy
Overall Impact on Community
Constructive Achievements
Nominator Information
Nominator First Last
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code
E-mail