2003 AAPBA AWARDS ENTRY FORM

(Provide 2 copies for each entry)

Check the following that apply:

Radio entry ____ Division 1 ___ 2 ___

Television entry ____ Division 1 ___ 2 ___ 3 ___

Category Number: _____ Category Name: ____________________________________________

(Type or CLEARLY print following information)

Title of Entry (This will be the title printed on any awards received)

__________________________________________________________________________________

Individual names to be printed on awards (Maximum of 4)

______________________________________ ________________________________________

______________________________________ ________________________________________

Broadcast length: __________

Contact person, phone number and e-mail address:

________________________________________________________________________