(1)Nomination Submitted by:________________________________________________________________________________ Address:

Phone and FAX Numbers:

E-mail Address;

(2)  NAME OF SOCIETY:

Address: ____________________________________________________________________________________________________________

TYPE OF SOCIETY: (  ] HISTORY  (  ]  GENEALOGY  (  ] PRESERVATION (  ] OTHER

(3)  NAME & ADDRESS OF PRESIDENT: _____________________________________________________________________________

(4)  ATTACH A STATEMENT OF SUPPORT FOR THIS ENTRY.

Statement should indicate why you think this entry is worthy of consideration based upon the following: these awards are presented in order to encourage and give recognition to those societies which have been actively engaged in one or more special and sign Meant projects anytime during the past TWO years. On-going projects are eligible for consideration. Submissions under this category should illustrate why the listed projects are special and significant, and should show what value is to be derived from said project(s).

After the entry has been judged, the entrant will be notified no later than I October with regard to the status of the entry. All winners will be informed as to the time and location of our annual meeting at which all awards are presented. If you have any questions, please write to the Society address:

NCSH, Inc., PO Box 93, Sherrills Ford, NC 28673-0093.

E-mail: ncsh@earthlink.net