Jane Mendel Tikkun Olam Award 2015-16

(To be awarded:  25 September 2016 at the Little Rock Marriott Downtown)

Nomination Form

Deadline: 30 June 2016

In order to assist us in presenting your honoree in our publicity and in the booklet that will be given to guests at our Tikkun Olam Award Celebration, please complete this nomination form as fully as possible. Please send a digital photo of your honoree via email to: federation@jewisharkansas.org.

Thank you.

General Information
Name of Honoree *
Name of Honoree
Honoree's Address *
Honoree's Address
Honoree's Phone *
Honoree's Phone
Reason for Nomination
Background
Form Submitted by *
Form Submitted by
Date
Date
Your Address *
Your Address
Your Phone *
Your Phone