2011 Biennial Awards Nomination Form

2011 Biennial Awards Nomination Form
Awards presented to individuals
* - required field
I. Name of Biennial Award for which you are making a nomination *
II. Nominee Information
Title	First Name *	Initial	Last Name *	Suffix
Ethnicity (Please check): *
African American Asian American European American Haitian			Hispanic/Latino Native American Other
Church membership *
Street *
City *			State *	Zip Code *
Region
E-mail address			Phone *
III. Nominator Information - Name of the person making nomination:
Title	First Name *	Initial	Last Name *
Street *
City *			State *	Zip Code *
E-mail address			Phone *

Please enter the characters shown above: (Entering this security code prevents SPAM)

Deadline for nominations is Oct. 21, 2010. We encourage you to submit your nomination on-line and send the required support documentation via fax, mail or as pdf attachments. By U.S. mail - must be postmarked by Oct. 21, 2010 - American Baptist Home Mission Societies, Attn: Susan Bogle, PO Box 851, Valley Forge, PA 19482-0851 By fax - must be faxed by Oct. 21, 2010 - Susan Bogle at 610.768.2470 By e-mail - must be sent by Oct. 21, 2010 - susan.bogle@abhms.org For more information, contact Susan Bogle at 800.ABC.3USA (800.222.3872) ext. 2028, or susan.bogle@abhms.org