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Nomination Form

If you would like to nominate someone for an award, please complete all the fields below and then click on the Submit button once. Alternatively, download a nomination form and fax it to us at 519-766-8688 or mail to ERCA, 360 Fairview Avenue West, Suite 311, Essex, Ontario N8M 1Y6.

Person / organization being nominated:

Nominee:
 Name/Organization
Contact Person: If Applicable
Address:
Telephone:
Fax:

Award Category:

Individual Organization Municipal
Education:  
Volunteer:
Environmental Achievement:

Nominated by:

Name:
Address:
Telephone:
Email:
About the Nominee:
 (denotes required information)