Championship Tree Form

Montgomery County

Nomination Form

NOMINATIONS MUST BE RECEIVED BY NOVEMBER 30, 2004


Name:___________________________________________________________________________

Street Address:____________________________________________________________________


______________________/___________/___________/______________________

City                                            State                 Zip                       Telephone

Location of Tree:______________________________________________________

____________________________________________________________________

Species of Tree (If known):_____________________________________

Height (in feet):_________

Width (spread) of the crown of tree (in feet):_______________________

Circumference around trunk at
4.5 feet above ground level (measured in inches):_________________________________________

Nominator:   

Name:_______________________________

Address:________________________________________
                ________________________________________
                ________________________________________

Phone:  _________________________________________

PRINT THIS FORM

Please send nominations to:
David Honchalk
                      Lathrop E. Smith Env. Ed. Ctr.
             5110 Meadowside Lane
        Rockville, MD 20855

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