Please return to:
The Massachusetts Council of Churches, 14 Beacon St., Ste. 416, Boston, MA 02108
RETURN BY SEPTEMBER 1, 2007
Name of Nominee:_______________________________________________
Telephone: (work)_______________________(home)___________________
Address:_______________________________________________________
______________________________________________________________
Church membership:______________________________________________
Priest/Pastor:___________________________________________________
Telephone:______________________________
Name of individual making the nomination:_____________________________
Telephone: (work)_____________________(home)______________________
Address:________________________________________________________
________________________________________________________________
Please describe, on the back of this form, the achievements of the nominee.
Other references: