Lion of Zion Nomination Form : The Moskowitz Prize for Zionism

Lion of Zion Nomination Form

PLEASE NOTE

Nomination can be either by the candidate or someone else
If you are submitting for yourself, please fill in your information in BOTH the submitters information as well as the candidates information
Deadline: January 28th, 17 Shvat

Submitter's Information

Name

Title

First Name*

Last Name*

Email

Email*

Phone Number

Phone Number*

Submitter's Relationship
with Candidate

words. Please limit to 50 words or less.

Candidate's Information

Name

Title

First Name*

Last Name*

Email

Email*

Phone Numbers

Main*

Work

Home

Other

About the Candidate

In 500 words or less, please describe why the candidate you are nominating deserves the "Lion of Zion" Moskowitz Prize for Zionism.*

words. Please limit to 500 words or less.

References

A minimum of one reference is required in order to complete the nomination process. Additional references may be added below.

Reference #1

Name

Title

First Name*

Last Name*

Position

words. Please limit to 50 words or less.

Relationship to the Nominee

words. Please limit to 50 words or less.

Email

Email*

Phone Numbers

Main

Work

Home

Other

Reference #2

Name

Title

First Name

Last Name

Position

words. Please limit to 50 words or less.

Relationship to the Nominee

words. Please limit to 50 words or less.

Email

Phone Numbers

Main

Work

Home

Other

Reference #3

Name

Title

First Name

Last Name

Position

words. Please limit to 50 words or less.

Relationship to the Nominee

words. Please limit to 50 words or less.

Email

Phone Numbers

Main

Work

Home

Other

Reference #4

Name

Title

First Name

Last Name

Position

words. Please limit to 50 words or less.

Relationship to the Nominee

words. Please limit to 50 words or less.

Email

Phone Numbers

Main

Work

Home

Other

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The Moskowitz Prize for Zionism