Criteria: To recognize individuals, groups and youth who have taken action to enhance and promote conservation of wildlife in the National Capital Region and whose contribution has shown sustainable results.
Category: Please Circle Individual (over 21) Group Youth (Group or Individual under 21)
Name and Address of Nominee:
Achievement for which the above is being nominated (use extra sheet, if necessary, and attach supporting documentation, if any):
Describe the positive impact on others and the environment:
Are there any future activities that will sustain these actions or projects?
Who is nominating the individual, group or youth (group or individual)?
Name:	Relationship of nominator to nominee:
Tel.:	Fax:	Email:
Address:	Signature of Nominator:
Date Submitted
Nominations must be sent to and be received by March 1st 2007: Madeline Kallio, NCR Wildlife Festival Coordinator Telephone: 613 831-2253 Fax: 613 831-4663 Email: mkallio@mondenet.com