| NOMINEE INFORMATION |
| Nominee's Full Name |
|
| Professional Name
Used |
|
| Address |
|
| City |
|
| State |
Zip |
| City / State of
Birth |
|
| Home Phone |
Work Phone |
| Fax |
|
| E-mail |
|
| List Station(s) where nominee has worked,
position(s) held, years & dates |
|
|
| Station
(1) |
Position Held
From Date To Date
|
| Station
(2) |
Position Held
From Date To Date
|
| Station
(3) |
Position Held
From Date To Date
|
| NOMINEE BIOGRAPHICAL INFORMATION |
Submit a brief
biography on nominee's broadcasting experience. Please list
experience, activities, and contributions to the field and the
community. Please note whether nominee is still in broadcasting,
other field, retired, etc.
"Cut and Paste" method may be used |
|
| NOMINATOR'S INFORMATION |
| Nominator's Full Name |
|
| Address |
|
| City |
|
| State |
Zip |
| Your Email: | |
| Home Phone |
Work
Phone |
** Note ** : Upon
acceptance of nomination, a photo of the nominee is required.
|
