Vincent R. Johnson Models of Hope Nomination Form

We are looking for individuals that not only the GLBT youth can look up to, but anyone the community can see as a ray of light for how it should be portrayed. If you know someone who should be on this list, please complete this form. The person(s) chosen will appear in the January-February issue of Pride & Equality magazine and be the guest of honor at the annual Model of Hope Awards Dinner at The Albuquerque Convention Center in Albuquerque, New Mexcio. All entries must be received by September 30, 2010.


IF THIS FORM DOES NOT WORK, PLEASE EMAIL THIS INFORMATION TO PRIDEEQUALITY@GMAIL.COM

*Full name of nominee:
*Occupation:
*Address:
*City:
*State:
Country:
*Zip:
*Phone Number (for verification only):
*Email:
*Full name of person nominating the nominee:
*Address:
*City:
*State:
*Zip:
*Phone Number (for verification only):
*Email:
*Why do you feel this person is a Model of Hope for the GLBT community? (If there is additional material to support this nomination, please fax to 877-599-6728
If any information is incorrect or not filled out, or if the nominee refuses to be selected, nomination will become null and void. So please make your nomination count!