Order of Manitoba
Nomination Form

I would like to nominate the following individual for the Order of Manitoba:

Name:
Address:		City:
Province:		Postal Code:
Telephone:
Home:		Business:

I feel that my nominee has demonstrated excellence and achievement, and has made a mark on our province and our people in the following ways:

Please attach any additional information regarding your nominee's accomplishments and send it to the address below. You may also ask up to three (3) other individuals to provide letters in support of your nomination.

My name is:
Address:		City:
Province:		Postal Code:
Telephone:
Home:		Business:

If you would prefer, a written application is available from the:

Secretary, Order of Manitoba Advisory Council
Room 338
Legislative Building
Winnipeg, Manitoba
R3C 0V8

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