D.A.R.E. LAW ENFORCEMENT EXECUTIVE OF THE YEAR AWARD
NOMINATION FORM
Deadline for nominations: May 30, 2000

NOMINEE INFORMATION

 Name________________________________________________________________________________________

Title__________________________________________________________________________________________

Organization____________________________________________________________________________________

Address_______________________________________________________________________________________

City___________________________________________ State _______________ Zip _____________

Telephone Number _________________________________ Fax Number _________________

E-mail Address________________________________________________
 
 

NOMINATOR INFORMATION

Name_________________________________________________________________________________________

Title___________________________________________________________________________________________

Organization_____________________________________________________________________________________

Address ___________________________________________________________________________

City _______________________________________ State_________________ Zip ___________

Telephone Number __________________________________ Fax Number __________________

E-mail Address__________________________________________________

Signature of Nominator ____________________________________________

(Your signature attests to the accuracy of your nomination submission.)