Nominations

Members of 100+ WWC Columbus, Mississippi, may nominate a local charity or an organization whose purpose is to benefit the public good. Nomination Forms are required to be submitted by midnight 30 days before the Impact Award Meeting or date of Impact Award announcement. All nominations will be vetted by the KISS Committee.

Please submit this form 30 days prior to the meeting so the committee can confirm eligibility of the organization you are bringing forth. You can find a pdf version of this form here.

The deadline for nominations for Fall 2021 is September 26, 2021.

Member Nominating

First Name

Last Name

Member Email (that is frequently checked)

Organization Name

Organization's Street Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Organization's Phone #

(###)

###

####

Organization's Website

http://

Organization's Contact Person

First Name

Last Name

Organization's Contact Phone #

(###)

###

####

Organization's Contact Email

Mission/Purpose of the Organization

Service Area of the Organization

My Relationship to the Organization