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RYG Award Nomination

Please print, complete, and fax to:    (603) 431-9464    Attn:  RYG Program Manager

Name of candidate                                                                                          
Activity/Code                                                                                          
Activity Head                                                                                              
Address                                                                                          
                                                                                         
                                                                                         

Reason for nomination:                                                                                          
                                                                                         
                                                                                         
                                                                                         
                                                                                         
                                                                                         
                                                                                         
                                                                                         
                                                                                         

Nominator's Name                                                                                            
Phone                                                                                          
Date