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* 1. Nominee _______________________________________________________________________________

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* 2. Nominee’s home address________________________________________________________________________

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* 3. Nominee’s Workplace and Position_______________________________________________________________

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* 4. Nominee’s Phone Numer_______________________________________________________________

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* 5. Your Name _______________________________________________________________

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* 6. Your Address___________________________________________________________________________________

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* 7. Your Email & Phone Number ___________________________________________________________________________________

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* 8. Please email the nomination and 1 page write up to both jeanmcmenimen@gmail.com and breanna.oxley@gmail.com or send to P.O. Box 2422 Cedar Rapids, Iowa 52406

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* 9. Nomination forms and write-ups are due by Friday, April 30th by 5 pm

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