Silver Circle Nomination Form

NOMINATION FOR SILVER CIRCLE SOCIETY
The Mid-Atlantic Chapter of the National Academy of Television Arts & Sciences accepts nominations for the prestigious Silver Circle Society.  The Silver Circle Award recognizes individuals who have outstanding service in broadcasting for a minimum of 25 years, with the majority of it being spent in the Mid-Atlantic Chapter. We accept nominations from broadcast journalism, talent, creative, technical, education, administrative and TV commercial production.  Induction of the 2018 Silver Circle Members will take place at our Emmy ® Gala on October 13, 2018. Any NATAS member may submit candidate names by using the form below. Nomination forms are due May 1 of each year.  Send nominations to tara@natasmid-atlantic.org.

To give the committee the best possible consideration, supplement this nomination form with:

– Details about specific career achievements
– Include importance of jobs in the Mid-Atlantic Region
– Letters in support of the nominee from peers, community members, etc.

NAME OF NOMINEE                                                                                                                     

ADDRESS                                                                           CITY/STATE                                      

DAYTIME PHONE                                                            EMAIL                                                

YEARS IN THE INDUSTRY                   YRS IN THE MID-ATLANTIC REGION                         

CURRENT JOB TITLE                                                                                                                   

EMPLOYMENT HISTORY   _____________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

COMMUNITY/OTHER  _________________________________________________________

SUBMITTED BY                                                           TELEPHONE                                           

EMAIL (for questions)                                                                                                                                             

((If needed, please use additional pages to list special achievements/notes))
TOTAL NUMBER OF ADDITIONAL PAGES _________