J. ALLEN POPE/REACHING OUT AWARD

AQUA / J. ALLEN POPE AWARD

REACHING OUT AWARD

2007 NOMINATION FORM

NOMINEE INFORMATION:

NAME________________________________________________________________________

ADDRESS: ___________________________________________________________________

CITY: _______________STATE________ZIP:______________PHONE:___________________

IN 300 WORDS OR LESS PLEASE EXPLAIN HOW THIS PERSON MADE A DIFFERENCE IN
OUR COMMUNITY AND SHOULD BE CONSIDERED FOR THE "REACHING OUT AWARD".
ALL INFORMATION MUST BE VERIFIABLE (USE BACK IF NECESSARY)

_____________________________________________________________________________

YOUR INFORMATION

NAME: _____________________________________________PHONE:___________________

ADDRESS____________________________________________________________________

CITY______________STATE______ZIP_________ E-MAIL: ___________________________

YOUR SIGNATURE: ____________________________________________________________

MAIL THIS FORM TO: AQUA POST OFFICE BOX 145 MOBILE, ALABAMA 36601

NOMINATION FORMS MUST BE RECEIVED BY THE AQUA COMMITTEE BEFORE

FEBRUARY 23, 2008. THE SELECTION OF THE RECIPIENT IS AT THE SOLE DISCRETION

OF THE AQUA COMMITTEE. THE AWARD MAY BE GIVEN POSTHUMOUSLY IF THE

PERSON SELECTED IS DECEASED.