NAME OF CANDIDATE:_____________________________________________________________________________________

Address:_______________________________________________________________________________________________________

Phone Number:_________________________ Fax Number:_____________________ E-Mail:___________________________

Occupation:___________________________________________________________________________________________________

(2)  WHAT HAS THIS PERSON/ORGANIZATION DONE TO BE CONSIDERED FOR THIS AWARD THAT DOES NOT FALL INTO ANY CATEGORY THIS SOCIETY RECOGNIZES?

 (3)  STATEMENT OF SUPPORT. Please provide us with as much information as possible in order to help the Awards Committee to make their decision. Provide any visuals, audios, etc.

NCSH, Inc.,

PO Box 93

 Sherrills Ford, NC 28673-0093

ENTRY DEADLINE: JUNE 30