Golden Ass Award Identified Nomination Form

Warning!.. if you use this form..
Your identity will be revealed to the Nominee 

If you with to remain anonymous you MUST use the 
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 

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

Identified Nominator Information: 

Required Fields  * - Form will not complete unless correctly filled in.

I want to deliver this award personally.  I will take great pleasure in watching the reaction of the person I want to nominate! 
Please send this award by first class mail to the address below so I may arrange delivery.

Name: *
Phone: *
Email:  *
Address: *
City: *
Suite/Apt: *
State/Province *
 Zip Code: *
Country: *
Fax Number:
URL: Web Address
Nominee Information
First Name: * Middle: Last *

 

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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