NATAS Mid-America Emmys® | Nomination Form

GOLD & SILVER CIRCLE
NOMINATION FORM

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GOLD & SILVER CIRCLE
NOMINATION FORM

Name

Address

City

State

ZIP

Day Phone

Evening Phone

Employment Status

If employed, list current place of employment

The following items must be attached and completed in full or the application will be disqualified.
PLEASE NOTE: only files with .doc .docx and .pdf extensions may be uploaded.

1. Letter stating why candidate is deserving of induction into Gold/Silver Circle^®.
Please craft this letter so those who may not know the candidate get a sense of who this person is, along with two letters of recommendation.

File 1

2. A comprehensive biography that outlines the nominee’s career path, work in the Mid-America area, involvement in organizations associated with the medium and key accomplishments.
Employment history and dates must be included.

File 2

3. First Letter of Recommendation:

File 3

4. Second Letter of Recommendation:

File 4

Submitted By

Contact Phone Number

Email Address

GOLD & SILVER CIRCLENOMINATION FORM

GOLD & SILVER CIRCLENOMINATION FORM

MID-AMERICA CHAPTER

GOLD & SILVER CIRCLE
NOMINATION FORM

GOLD & SILVER CIRCLE
NOMINATION FORM