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Prominence Point Nomination Form

Name of Nominee

First name

Last name

Contact information for Nominee or Family Member of Nominee:

Name

Address

Phone number

In what way has the nominee brought local, regional, provincial or national recognition to the City of Brantford?

Please describe nominee’s biographical information and his or her connection to the City and its historic or contemporary development (i.e. the nominee was born here, lived here during a formative time in their career, etc.)

Why is it important to recognize the nominee as part of Prominence Point? What is exceptional about this individual’s contribution to the City of Brantford?

Please attach at least one clear photograph of the nominee and copies of supporting documents to support your nomination (i.e.: newspaper clippings, testimonials, awards, photographs, web links, or other pertinent information)

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Name of Nominator

Address

Phone number