Ambassador Sign-up Form

Ambassadors are employees from across the Commonwealth who will help celebrate Virginia Public Service Week at the Governor's Awards Ceremony, to be held the week of May 4-10, 2009. This is a significant opportunity to say "thank you" to award recipients and to recognize thousands of hard working state employees on behalf of other employees.

Please submit your request by April 3, 2009. All fields are required.

First Name:
Middle Initial:
Last Name:
Agency:
Agency Location:
Job Title:
Work Phone:  
Work Email:     
Supervisor's Last and First Name:  
Supervisor's Email:
Supervisor's Phone: