NOMINATION FORM – City Of Florence

CITY OF FLORENCE, ALABAMA
WALK OF HONOR
NOMINATION FORM

Please review the Selection Policies and Procedures before submitting this nomination:

1. Nominee:

Name: *

Current Address:

(Not applicable if deceased)

Layout

Home Phone:

Work Phone:

Lauderdale County Native:

Inclusive dates of Lauderdale County Residency:

Inclusive dates of Lauderdale County Residency:

From

If Nominee is deceased, list contact information for nearest family member of Nominee.

If Nominee is deceased, list contact information for nearest family member of Nominee.

Name *

Home Phone:

Work Phone:

Address:

Relationship of contact person to the deceased Nominee:

2. Brief Biographical Sketch of Nominee:

3. Walk of Honor Achievement:

3. Walk of Honor Achievement:

Date(s) of Achievement

Describe significant contribution made by the Nominee:

4. Nomination submitted by:

4. Nomination submitted by:

Name *

Address:

Home Phone:

Work Phone:

Signature of Nominating Individual:

Date

5. Administration:

If you have questions regarding the Walk of Honor nomination process, please contact the Mayor’s Office at (256) 760-6400 (office) or (256) 760-6388 (fax) or ehenley@florenceal.org.
Please review the criteria for nomination in the Selection Policies and Procedures before submitting a nomination.

Submit completed Nomination Form and include supporting documents/picture (if available) to:

Click or drag files to this area to upload.You can upload up to 10 files.

Welcome to Florence, Alabama