2009 MARIN WOMEN’S HALL OF FAME

NOMINATION FORM   

DIRECTIONS:  Please type or prepare on computer.  Use  10 pt. or larger font. Direct questions to the Hall of Fame at 415/455-4900.  Answers to each question may not exceed one 8.5 x 11-inch piece of paper.  Attachments are not permitted.  Nominations are due by midnight, Friday, November 7, 2008 and should be sent to:
Marin Women’s Hall of Fame,  P.O. Box 4142, San Rafael,  CA  94913-4142

NOMINEE INFORMATION

NOMINEE’S NAME:_______________________________________________________
Note:  If nomination is posthumous, please indicate a contact name in this woman’s family that we may contact should she be selected.
__________________________________________________________________________
contact name                                                   relationship                                           phone number           

HOME ADDRESS:__________________________________________________________

___________________________________________________________________________

HOME PHONE:________________________  WORK PHONE:______________________

FAX:______________________________  E-MAIL:________________________________

OCCUPATION:______________________________________________________________

LENGTH OF TIME LIVING/WORKING IN MARIN______________________________

 CATEGORIES NOMINATED IN: (check up to three)

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  NOMINATORS INFORMATION

             NAME:________________________________________________________________

 ADDRESS:_____________________________________________________________

 _______________________________________________________________________

 HOME PHONE:_________________________  WORK PHONE___________________

 FAX:____________________________  E-MAIL:________________________________

HOW DO YOU KNOW THIS WOMAN – PLEASE TELL US ABOUT YOUR RELATIONSHIP WITH HER.

 QUESTIONS:

Ø      There are three questions regarding the woman you are nominating.  Each question is located on a separate page following this page.  Please refrain from exceeding one page, size 10 font or larger.  

To the best of my knowledge, the information provided here is accurate and may be used for program and press releases.  I am willing to be contacted to answer  questions regarding this nomination.

 signature of nominator_________________________________ date:_______________________

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NOMINEE’S NAME:___________________________________________________

 note – when answering this question, please address the characteristics and
          attributes listed in the Nomination Criteria.

  Actions ~

1.       Please describe what your nominee did. Please feel free to elaborate to fully
describe relevant information. 

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NOMINEE’S NAME:_____________________________________________________

 note – when answering this question, please address the characteristics and
          attributes listed in the Nomination Criteria.

  Qualities ~

 2.    Please describe this woman’s qualities. 

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NOMINEE’S NAME:________________________________________________________

 note – when answering this question, please address the characteristics and
            attributes listed in the Nomination Criteria.

  Anything Else ~

3.  Please provide any other information you believe will help the selection committee
     know this woman.  

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