2018 Gold & Silver Circle Form

Deadline is Wednesday, August 15, 2018

Candidate Name:

Street Address

City/Town:

State:

Zip Code:

Phone Number:

Email Address:

Date & Place of First Employment:

Present Occupation & Title:

Gold or Silver Candidate?:


Community Contributions:

List any associations or volunteer work.

Teaching or Educational Training Experience:


Nominated by:

Street Address

City/Town:

State:

Zip Code:

Phone Number:

Email Address:

Nominator's Recommendation:

Please state in your own words, the reasons this person should be inducted into the Gold or Silver Circle.


Attach Supporting Material: should include but not limited to; resume, letters from colleagues, community leaders or others who can speak to the candidates impact on the television industry and/or their community.
File types accepted for uploads are: .doc, .docx, and .pdf


Additional Supporting Documents: List awards or honors, newspaper, magazine, trade publication articles, and photographs of historical interest.
File types accepted for uploads are: .doc, .docx, and .pdf



Final Review: Please review information on the form the before checking the accept box.

ACCEPT