National Association of Broadcasters

International Broadcasting Excellence Award Nomination Form

Deadline: 12 FEBRUARY 2010

Please complete the online form below.

You can also Mail or fax the nomination form to: National Association of Broadcasters, 1771 N Street, N.W., Washington, D.C. 20036 USA, Attn: Emily Dorey

Station Name:		Web site:
Street Address:
City:		Country:
Phone (country code):	(city code):	Phone:
Fax:
Chief Executive of Station:		Business Title:
EMail:		Web link for supplemental info:
Person Submitting Entry:		Business Title:
Person Submitting E-mail:

Station Facts: (Please select the facts below for your station)

TV	Radio	Satellite	Terrestrial
National	Regional
Private	Government
Single Station	Channel	Group	Stations in Group:

Answer Only One of the Following Two Questions

Question 1: What have you done to improve the lives of your community?
This includes efforts made in your broadcast programming and other kinds of community involvement and activities beyond using the airwaves. Please list your top community service campaigns for the approximate two year period from 1 January 2008 through 31 January 2010. (Please do not exceed 500 words).

Please tell us your story in the overview section. Include the following points in your entry.

Event name and objective
Any organization(s) that benefited from your campaign
Whether your station was a primary organizer or support sponsor
On-air support prior, during and after event
Estimate of station staff hours contributed; volunteers mobilized, etc.
Results (any amounts raised - explain in USD; feedback from community; awareness raised or improvement made; if event was produced, what was total attendance; value of airtime donated, etc.)
Photos/Video/Audio (if you desire to include these items, please provide a Web link for us to view)

OVERVIEW (Please do not exceed 500 words; single space only).

Question 2: Innovation
Please describe how your station or channel has significantly contributed to the advancement of broadcasting through effective utilization of resources. NAB does not require that the technology or processes you employ be exclusively owned by your organization.

OVERVIEW (Please do not exceed 500 words; single space only).

**Have you checked to make sure you have met all criteria before you submit? If not, please read the criteria.

Questions? Call Emily Dorey at +1 202 429 5360; Fax +1 202 429 5461; E-Mail: edorey@nab.org

By applying for the Award, I consent to NAB's collection and storage of the data on this form in the United States.