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Nomination Form

Happy Holidays!  Medford Cooperative believes deeply that being a good neighbor helps strengthen our communities.  This holiday season, Medford Cooperative wants to offer extra support to individuals or families that are in need.  Please help us by submitting nominations for people in our communities that could use a helping hand during the holiday season.
Medford Cooperative will be selecting two nominees each week in December to receive a $150 gift card of their choosing, to either a Medford Cooperative grocery store location or C-Store.  This program will run November 27th through December 22nd.
Please limit your entries to one per nominee.  Multiple entries will not increase your nominee’s chances of being chosen.

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* 1. Your Name (Nominator)

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* 2. City of residence

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* 4. Phone

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* 5. Nominee's  Name

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* 6. City of residence

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* 8. Phone

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* 9. Reason for Nomination

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