SHARLOT HALL AWARD

To a living Arizona woman who has made a valuable contribution to the understanding and awareness of Arizona and its history. Presented annually by the Sharlot Hall Historical Society, the Award will be announced in April.

To make a nomination, please complete the following:

Nominee (include maiden name) _______________________________________

Address __________________________________________________________

__________________________________ Telephone _____________________

Place of Birth _______________________ Date of Birth __________________

Residence in Arizona _________________ Approx. Dates _________________

Professional/Field of Interest __________________________________________

On separate page(s), please submit supporting information on the nominee.

This information should include:

Person submitting nomination:

Name: ____________________________________________________________

Address __________________________________________________________

__________________________________ Telephone _____________________

"I certify that the above statements and all related attachments to the nomination are true and correct. I understand that the Award selection will be judged principally on the information provided by these applications."

__________________________________
(Signature)
Nominations must be postmarked by September 30 of this year.  Mail nominations and supporting material to: Sharlot Hall Award, 415 W. Gurley St., Prescott  AZ 86301.