Gift Flag Program, Nomination Form

Your Name (required)

Street or P.O. Box (required)

City (required)

Zip (required)

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Your Email (required)

Telephone Number

Fax Number

Name of your Pro-flag Group (if applicable)

______________________________________________________________________________________________

Make your nomination below by selecting the type of location you are nominating.

BusinessChurchGovernmentSchoolHomeOther

If Other location please describe

Name of Facility or Location (required)

Flags and Poles Currently at Location (required)

Name of Best Contact Person (if known)

Street and/or P.O. Box (required)

City, State, Zip (required)

Email (if known)

Phone and Fax Numbers (if known)

Have nominees been notified of nomination? If yes, please explain.

Why should this location receive a Gift Flag, and what size do you suggest?

I attest that I have read and consent to the Terms & Conditions of the Mississippi Gift Flag program of Flags Across Mississippi

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