NATIONAL TELEVISION ACADEMY
UPPER MIDWEST CHAPTER

THE SILVER CIRCLE
Nomination Form

The Silver Circle is open to all who began their careers in television at least 25 years ago, either in a performing, creative, technical or administrative role within the industry or in a peripheral area directly related to television, such as commercial production, journalism, or education.

Nominees must have made a significant contribution to our industry in the Upper Midwest for at least part of their career.  Consideration will be given to candidates who are living or deceased.

Candidates or their sponsors are asked to submit the following information for evaluation by the Board of Governors of the Upper Midwest Chapter of the National Television Academy.

Send Nomination Form and additional materials by June 20, 2003 to:	  
NTA, Upper Midwest Chapter
4967 Kensington Gate
Shorewood, MN  55331



Nominee__________________________________ 	Telephone (Day)			

Address______________________________________    (Evening)			

City___________________________________________State___________Zip________

Years of employment in television in the Upper Midwest:

From_________________To_________________________

Please list places of employment in television:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Present occupation    ______________________________________________________

Are photographs, films or tapes of historical interest are available?  ( Yes	( Unknown

Please attach a brief biography or resume with application. 

Submitted by_______________________________ Telephone (Day)			

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