Mayor Lyle Anderson Gold Leaf Award for Volunteer Service Adult Nomination Form

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PURPOSE OF AWARD: The purpose of the Mayor Lyle Anderson Gold Leaf Award for Volunteer Service is
to honor outstanding citizens who are making valuable contributions to the community
through volunteer service in a wide variety of categories, such as health, recreation,
arts, environment, education, public safety, civic service or other human services.

QUALIFICATIONS FOR AWARD: The volunteer must be a resident of Lebanon,
or the volunteer service must be performed in Lebanon. The volunteer must be age
18 or older. The volunteer activity can be in a structured setting or on an informal basis. For more information, email dgean@lebanonmo.org or call 417.991.2310. Nominations must be submitted by 5 p.m. April 7.

Nominee's Name - First and last *

Nominee Street Address

Nominee City *

Nominee State

Nominee Zip

Nominee Phone Number

Nominee email address *

Detailed description of Volunteer Activity *

Was the volunteer activity performed in Lebanon? Where?

Your Name - First and Last *

Relation to the Nominee *

Your phone Number *

Your email address *

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