The Moskowitz Prize for Zionism
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Nominations must be submitted by 8 Tevet 5772 - January 3rd 2012

If you are having trouble viewing this form please contact us at info@moskowitzprize.com

Candidacy Submission Form

 Candidate's Details
First Name :  
Last Name :  
Home Address :  
Telephone (Home) :  
Telephone (Work) :  
Telephone (Cellphone) :  
Email :    
Work Position/Title :  
Place of Employment: :  
Work Address:  
Work Telephone :  
Are you completing the candidacy form for another person?:
In what field do you view the candidate's main contribution to Israeli society?
Short explanation of the reasons for the candidacy:
Maximum 100 words (500 characters)  
List of References (minimum of three; if you don't have an email address for the References please put in you own email address):
 
Name of ReferenceTel. 1Tel. 2Email
       
       
       
Please copy the the above letters
into the box below
      

Please contact us if you are unable to submit this form. info@moskowitzprize.com or 02-6262904