Arizona Ice King Nomination

Please use the form below to nominate a person or family for up to $500 toward their utility bill.

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Your Name

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Last

Your Phone *

Your Email *

Name of person you're nominating *

First

Last

Phone number for the person you're nominating *

Email for the person you're nominating *

Address of the person you're nominating *

Address Line 1

Address Line 2

City

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Zip Code

Briefly tell us why you're nominating this person or family *

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