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2. Award Category

   1. Samuel J. Pilson Outstanding Volunteer Fire Officer of the Year
   2. Claude A. Cobler Outstanding Volunteer EMS Officer of the
   3. Outstanding Volunteer Fire Department Member of the Year
   4. Outstanding Volunteer Rescue Squad Member of the Year
   5. Outstanding Volunteer Junior Member of the Year
6. Nominee Information

   The section below is about the nominee

8. Name*
10. Address*
12. City*
13. State*
14. Zip Code*
16. Phone Number*
18. Nominee's Agency Affiliation*
20. Years of Service*
22. Office Currently Held
26. Submitting Person's Information

    The section below is about the person submitting the nomination form

28. Name*
30. Address*
32. City*
33. State*
34. Zip Code*
36. Phone Number*
40. The section below is for qualifying information and/or documents

    Please attach other qualifying information and documenting materials.  This shall be a minimum of a 1 page letter of recommendation but not to exceed 3 total pages per nomination or the equivalent of 750-2500 words.

    
    

    Please either type the qualifying information in the space provided, or upload the document below.

42. Qualifying Information
44. Upload a file
Leave This Blank:


46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit

* indicates a required field