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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