(306) 522-3232

The Caregiver Award Nomination Form

Please complete the following form to nominate someone for The Speers Caregiver Award.

For more information, please contact Heather Wenarchuk at hwenarchuk@speersfuneralchapel.com or call (306)522-3232.

Please enter the contact information of the person submitting the nomination.

Name (Nominator)*:

Phone*:

Email*:

Please enter the contact information of the nominee in the fields below.

Name (Nominee)*:

Phone*:

Email*:

Address*:

City*:

Country*:

State/Province*:

Zip/Postal code*:

Employer's Name (if applicable):

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Email*:

Name*:

Message*:

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Please enter the numbers and letters you see in the image. Note that the case of the letters entered matters.*:

Contact Information