Golden Ass Award Anonymous Nomination Form

Please select the category or occupation you want cited in the nomination:
This will be indicated on the nomination certificate and will determine the category under which the individual will be listed in the

International Book Of Asses

This information will only be used by The Golden Ass Award
Your identity will not be divulged to the Nominee.

This information is kept strictly confidential and will not be sold or distributed
to any other entity without the our client's permission.

Anonymous Nominator Information:
Required Fields * - Form will not complete unless correctly filled in.

Name: *
Phone: *
Email: *
Address: *
City: *
Suite/Apt: *
State/Province *
Zip Code: *
Country: *
Fax Number:
URL: Web Address
	Who are you nominating? Please send this award by first class mail to the following address and keep my identity confidential.
First Name: *	Middle: Last *
Phone: *
Address: *
City: *
Suite/Apt: *
State/Province *
Zip Code: *
Country: *
Fax Number:
URL: Web Address
Email:
Please select the category or occupation you want cited in the nomination: This will be indicated on the nomination certificate and will determine the category under which the individual will be listed in the: International Book of Asses Required Entry * Optional): Write a brief description (100 words or less) indicating the specific acts of arrogance that qualify this person for the award. S.C.R.A.P. may use this as evidence in determining the winners of the annual Golden Onager Award.

Please the Information (Reset Form)

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Jamul, CA 91935

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