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City of Rock Island Citizen of the Year Online Nomination Form

  1. Category: (Check One)
  2. Would like to remain anonymous?
  3. Please list contact information for an additional reference you would like us to contact regarding your nomination.

  4. If you have any questions, please call the City Clerk's office at 309-732-2012.

  5. Leave This Blank:

  6. This field is not part of the form submission.