Chambly County High School / Chambly Academy
WHO’S WHO DIRECTORY
On-line Nomination Form

To nominate a person to the Who's Who Directory, submit this form. You can also submit your nominations via regular mail to:

Alumni Association - Who's Who Committee
Chambly Academy
675 rue Green Street
St. Lambert, Quebec J4P 1V9

Please provide as much information as possible including qualifications, awards, involvement and contributions to help our selection committee in the decision making process.

Nominee Information

Name of Nominee:
Graduation Year:
Address:
City:
Province:	Please Select New Brunswick Newfoundland and Labrador Nova Scotia PEI Quebec Ontario Manitoba Saskatchewan Alberta British Columbia
State or Country:
Postal Code:
Phone Nr. (area code) xxx xxxx:
Nominee E-mail Address:

Your Information

Name of Nominator:
Nominator Graduation Year:
Nominator Tel.Nr. & email address:

In what field did the Nominee achieve prominence?

Please give a brief biography of the person you are nominating