Submission

Part 1: Personal and Business InformationPart 2: Nominee’s Career InformationPart 3: In the Words of the NominatorPart 4: PreferencesPart 5: AppendixPart 6: Declaration Form
Children’s names and ages (if applicable)
List most important published works and brief description of each.
List two authorities of references supporting the nomination.

First Authority

Second Authority

THE FOLLOWING SECTION MUST BE COMPLETED BY THE NOMINEE

I attest to all facts contained in my nomination form and give permission for the facts to be used for publication. I hereby declare that I agree to the selection and I and willing to be proposed as a nominee for the JCI TOYM and if I am selected I will attend the awards presentation except in the event of unforeseen circumstances

THE FOLLOWING SECTION MUST BE COMPLETED BY ANY LOCAL ORGANIZATION REGISTERED UNDER ROS AND ROY:

THE FOLLOWING SECTION MUST BE COMPLETED BY THE NOMINATOR:

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