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2. 
4. NJLM Elected Officials Hall of Fame

   Confirmation of the nomination will be mailed to the nominee in March 2023

6. Official's Name
7. Title
9. Municipality
11. Address
13. City
14. State
15. Zip Code
17. Phone Number
18. Email
20. Dates in office as mayor or member of the governing body (must total 20 years).
    Please list dates in office, titles
24. Name of Individual Completing Form
25. Email Address
27. Date Form Completed
29. Phone Number
30. Fax Number
32. Please keep a copy for your records
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit Submit and Print

* indicates a required field