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Rotary business nomination
Small Business Award Nomination
Nominee
Name of Business nominated
*
Type of business/service
*
Business address
*
Business phone
Business email address
Has the business been notified of this nomination?
*
Yes
No
Nominator
Name of Nominator
*
Phone
*
Email address
*
Date
*
Reason for nomination (Maximum 100 words).
This information will form the basis of the citation on the presentation night. If insufficient space, please send further information (contact details below).
0 / 100
Submit Nomination
Please do not fill in this field.
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