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HISTORIAN OF
THE YEAR AWARD [The
recipient of this award MUST
appear at our annual meeting in October [
] EAST
[ ] WEST |
NAME
OF
CANDIDATE:
[
] MRS.[ ] MR.[ ] MS. [ ] MISS [ ] DR./PhD.
ADDRESS________________________________
CITY______________________, NC
ZIP_____________
TELEPHONE
# [
] ________________________COUNTY OF
RESIDENCE________________________
STATE
OF BIRTH: ________________________________ COUNTY
OF BIRTH: ______________________
HOW LONG A RESIDENT OF THIS STATE?___________
OCCUPATION: ___________________________
Please
answer the following questions either in the space provided or attach extra
sheets. Pleasee mark the attached sheets as: Exhibit A, Exhibit B, etc,
(The exhibit letter to correspond with the question letter).
(A)
WHAT HISTORY AND/OR GENEALOGICAL SOCIETIES DOES CANDIDATE BELONG TO, OR HAS BEEN
ASSOCIATED WITH IN THE PAST?
(3)
ANY PRESENT OR PAST OFFICES HELD IN ANY
OF THE ABOVE ORGANIZATIONS BY THE CANDIDATE? [Place an by any office
presently held. by the candidate].
(C.) THE PRIMARY AREAS OF INTEREST
OF THIS CANDIDATE ARE:
[ ] Historical
Research
[ ] Genealogy
[ ] Historic
Preservation
[ ] Archaeology
[ ] Local History
[ ] War Between the
States
[ ] Revolutionary War
[ ] Other (Indicate
what)
(D.) IF LOCAL HISTORY, DETAIL WHAT IS THE
SPECIFIC INTEREST IN LOCAL HISTORY'
(E
) IF GENEALOGICAL HISTORY, LIST THE FAMILY NAME(S) BEING RESEARCHED. INDICATE
THE STATE AND COUNTIES OF GENEALOGICAL RESEARCH INTEREST.
(F)
DOES
THIS CANDIDATE HAVE PUBLISHING CREDITS IN HISTORY?
IF SO, LIST BELOW, SHOWING TITLES AND
DATES OF PUBLICATION.
(G)
ON AN EXTRA PAGE MARKED "EXHIBIT
0," LIST IN DETAIL THE REASON WHY THIS NOMINEE SHOULD BE CONSIDERED FOR
THIS MOST PRESTIGIOUS AWARD. LIST ALL HISTORICAL, GENEALOGICAL OR
PRESERVATION ACTIVITIES WITHIN THE PAST 2
YEARS THAT WOULD QUALIFY THIS NOMINEE,
THIS
NOMINATION WAS SUBMITTED BY:
NAME
& TITLE [Mr , Mrs., Miss, Ms., Dr,,
PhD]: ADDRESS [CITY, STATE, ZIP CODE]:
_________________________________________________________________________
________________________________
TELEPHONE
[
] ________________________
[ ]HOME [ ]BUSINESS
E-MAIL ADDRESS:_________________________________________________________________________________________
FAX
# [ ] _______________________________________________________________________________________________
NCSH,
Inc., PO Box 93, Sherrills Ford, NC 28673-0093
