NATAS: National Academy of Television Arts & Sciences National Academy of Television Arts & Sciences

THE NATIONAL ACADEMY OF TELEVISION ARTS & SCIENCES
PACIFIC SOUTHWEST CHAPTER SILVER CIRCLE NOMINATION FORM

The Silver Circle is open to individuals who began their careers in television at least 25 years ago, either in a performing, creative, technical or administrative role within the industry or in an area related to television such as TV journalism education, advertising, promotion, and public relations. The candidates must also have made a significant contribution to Pacific Southwest television for at least part of their 25-year career.

Only current residents of the Pacific Southwest region are eligible. Candidates are selected for evaluation and selection by a special Silver Circle Committee appointed by the Chapter Board Of Governors composed of five Silver Circle members and five chapter members.

Submit your nomination by filling in the form below:

(While we prefer nominations electronically, we have a printer-friendly nomination form available here.)

Nominating for:

Name of Honoree:


Nominee Address:


City:


State:


Zip:


Telephone/Day:


Telephone/Evening:


E-mail:


Date & Place of First Employment in Television:


Years of Employment in Television:
From To

Places of Employment in Television:


Briefly State Significant Contributions to Television:


Current Occupation:


Submitted by:


Company:


Address:


City:


State:


Zip:


Telephone:


E-mail:
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