I would like to nominate:  
 
Clerk's First Name*
 
 
Clerk's Last Name*
 
 
 
Title*
 
 
 
Municipality*
 
 
 
Clerk's Email*
 
 
 
I'm nominating this Clerk because*
 
 
 
Mailing address (for certificate and pin delivery):  
 
Street Address*
 
 
 
City*
 
 
 
State*
 
 
Zip*
 
 
 
 
 
Submitted by:  
 
First Name*
 
 
Last Name*
 
 
 
Your Position*
 
 
 
Your Email*
 
 
 
Your Municipality*
 
 
Your State*
 
 
 
 
 
It’s okay to share this nomination to social media.
 
 
 
This nomination may be shared with the Honoree