| Check One: |
| Brian Jones Export Award___ Peter Girard Investigative
Award___ |
|
Nominee:____________________________________________________ |
|
Agency/Company:____________________________________________ |
| Agency/Company Head:______________________________________ |
| Phone
Number:__________________________Fax:________________ |
|
Address:____________________________________________________ |
|
City/State-Province/Zip:______________________________________ |
|
Country:____________________________________________________ |
| Person
Submitting:__________________________________________ |
|
Phone:________________________________Fax:_________________ |
|
Address:____________________________________________________ |
|
City/State-Province/Zip:______________________________________ |
|
Country:_____________________________________________________ |