Health & Wellness

INSTRUCTIONS:

To Nominate Your Business: Please complete the online form below (Parts 1 and 2) OR Download the Self-Nomination Form.

To Nominate Another Business: Please complete the online form below (Part 1 only) OR Download the Third Party Nomination Form.

**Please Note: You have the opportunity to nominate a business in up to 2 categories. Check out the full list of categories. Businesses nominated in multiple categories MUST only select 2 categories to put forth for submission.

Nomination Deadline: Wednesday, May 24th 2017 at 4:30pm

Early Bird: Submit your nomination by Wednesday, May 10th at 4:30pm for a chance to win 2 FREE tickets to the event!

Nominated Company *

Contact Name *

Contact Name

First Name

Last Name

Phone

(###)

###

####

Email Address (if available)

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Website

http://

Your Contact Information

Your Name (required) *

Your Name (required)

First Name

Last Name

Your Phone Number (required) *

Your Phone Number (required)

(###)

###

####

Your Email Address

Part 1 - Please Complete

100 Word Description (required) *

In approx 100 words, please describe why you feel this company should be nominated based on the above criteria:

Part 2 - please complete if you are nominating your own business

Please Read carefully

This is your opportunity to tell us about your business. the following information is required, as JUDGING WILL BE BASED ONLY ON THE INFORMATION PROVIDED. Judges will assign a score (0-3) for each section. The more thorough, comprehensive and/or informative the application, the higher the potential points score.

Describe Company Operations and Customers (e.g., year established, number of employees, market served, etc.) (max. 200 words):

Promotes Wellness and Vitality (max. 200 words):

Demonstrates the Importance of Educating Individuals and the Community at Large to Achieve Optimal Health (max. 200 words):

Demonstrates the Importance of Inspiring Individuals and the Community at Large to Achieve Optimal Health (max. 200 words):

Community Involvement (max. 200 words):

Health & Wellness

SPONSORED BY PETERBOROUGH REGIONAL HEALTH CENTRE

INSTRUCTIONS: