(Please print to complete and submit.)

Nominee(s):                                                                                                                                      

 

Published in/broadcast on:                                                                                                               

 

                                                                                                                                                         

 

Title of Nominated Piece:                                                                                                                

 

                                                                                                                                                         

 

Date(s) Appeared:                                                                                                                            

 

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Contact info for nominee (phone, email, etc):

                                                                                                                                                        

 

                                                                                                                                                        

 

 

Brief Biography of Nominee (if you know):

 

                                                                                                                                                        

 

                                                                                                                                                        

 

Please enclose 1 copy of nominated entry if print or electronic media. Please enclose 4 copies of the nominated entry if video or audio media (entries will not be returned).  

All nomination forms and entries should be sent by March 31st, 2007 to:

Sally Bannen

MLA Communications Committee

Windham Public Library

Windham, ME 04062