2006 NOMINATION FORM

National Electronics Industry Hall of Fame
3608 Pershing Ave
Fort Worth, TX 76107-4527

NOMINATIONS MUST BE RECEIVED AT THE NEIHOF OFFICE BY MAY 5, 2007

I/We do hereby nominate:

Name in Full and Title


Address Street or P.O. Box


City State, Zip Code


Age


If deceased, date of death


To the National Electronics Industry Hall of Fame and do attest that the information and statements contained in this nomination form are true and correct to the best of my/our knowledge.

Signature of Nominators:

Name

Address

Phone



Name

Address

Phone



Name

Address

Phone



NOMINATION DOCUMENTATION


Divisions:
1) Scientists, Inventors & Engineers
2) Business & Industry
3) Communications
4) Association Executives
5) Industry Association Members
6) Outstanding Individuals who do not clearly fit any of the other groups

Division of N. E. I. H. O. F.:



Primary Qualifications which may entitle nominee for selection:























* If additional space is required for answers attach an additional sheet.


Last position held:









Hobbies:









Military information:









Special interests:









Fraternal service clubs:









Civic activities organizations:









Business organizations-associations:









Professional organizations:
List honors and awards received









List names of key people in industry, business associates and personal friends that may be able to provide further information.









Notes:
An application fee of $150 is required with each nomination. Enclose application fee, made payable to NEIHOF, with this form.

2006 NOMINATIONS MUST BE RECEIVED AT THE NEIHOF OFFICE BY MAY 5, 2007.

If possible, attach a black and white "slick" photograph of the nominee (head and shoulders shot).

Mail to:
NEIHOF (National Electronics Industry Hall of Fame)
3608 Pershing Ave
Fort Worth, TX 76107-4527

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