AFN ENTRY FORM

TELL US WHY

FIRST NAME:

LAST NAME:

PHONE NUMBER:

E-MAIL:

ENTER YOUR CATEGORY OR CATEGORIES HERE:

Business industry

MY MOB:

1.GIVE US SOME BACKGROUND INFORMATION ABOUT YOU:

2. WHAT ACHIEVEMENTS ARE YOU MOST PROUD OF:

3. HAVE YOU HELPED COMMUNITY, OR HAD A POSITIVE IMPACT FOR MOB?:

4. IF YOU COULD DO ONE THING, LEAVE A MARK ON THR INDIGENOUS COMMUNITY, WHAT WOULD IT BE?:

5. HOW WOULD YOU USE BEING THE RECIPIENT OF THIS AWARD TO INFLUENCE OTHERS AND HOW WOULD IT IMPACT YOUR CAREER/VOICE/COMMUNITY/MOB?:

6. ANYTHING ELSE TO ADD?: