Books For Readers Entry Form

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Fill out and submit the nomination form below online, or you can print it and then mail it in.

 

Your Name*

Your Email Address*

Your Phone Number*

Regional Chapter*

I nominate*
(Name of organization)

Reason for Nomination*

Contact Name and Title*

Contact Email Address*

Contact Phone Number
(Include country code if not US)

Nominee Website URL

 

* Required Field