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2. 
4. Dinwiddie County Lifetime Achievement Award

   Please complete and submit this form to nominate a Dinwiddie County native or current resident to receive the Dinwiddie County Board of Supervisors' Lifetime Achievement Award.  

   Once received, your nomination will be reviewed, and you will be contacted with additional information.

6. Full Name of Nominee*
8. Address1
10. Address2
12. City
13. State
14. Zip
16. Nominee's Phone*
18. Nominee's Community Service*
20. Nominee's Professional Achievements*
22. Nominee's Volunteer Activities*
24. Nominee's Other Civic Engagement*
26. High School and Year of Graduation*
27. College and Year of Graduation*
29. Hobbies and Other Interests*
31. Nominee's Family (parents, siblings, spouse, children, grandchildren, etc...)*
33. Why is this individual being nominated for a Lifetime Achievement Award?*
35. Full Name of the Person Making this Nomination*
37. Address of Person Making Nomination*
39. Address2
41. City
42. State
43. Zip
45. Phone Number of Person Making this Nomination*
47. Email of Person Making the Nomination*
Leave This Blank:


49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

51. Submit

* indicates a required field