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Assemblywoman
Michaelle C. Solages
Assembly District 22
 
Women of Distinction Nominee Form
October 2, 2013

Please take a moment to nominate a woman in our community for her outstanding contributions to make Assembly District 22 stronger, safer and better for our families. My selection committee will review all nominations for notable women in the fields of;

  • Civic and community affairs
  • Education
  • Law Enforcement
  • Religious
  • Breast cancer survivor/advocacy
  • Business

I encourage you to take this opportunity to nominate a woman who deserves this special distinction.

Please include the name and contact information of the Nominee in the form fields below.

Title
First: *
     
Mid:
Last: *
     
Suffix:
Address: *
     
Apt #:
City: *
     
State: *
     
Zip: *
Phone: *
* Indicates Required Field

Survey Questions:

I wish to nominate the above-mentioned woman for Assemblywoman Solages' WOMEN OF DISTINCTION award in the following category (civic and community affairs, education, law enforcement, religious, breast cancer survivor/advocacy, or business)
Please write a description of the nominee and her contribution
Name of nominating individual
Address of nominating individual
Zip code
Telephone
 
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