Nominate a Reformer

Submitted by mfarrington on Thu, 2010-12-02 14:30

Please complete this form to nominate someone for an Award for Achievement in Drug Policy Reform.

Your Information

Contact information for the person making the nomination:

Name: *

Organization: *

Job Title:

Email: *

Phone: *

Relationship to Nominee: *

Name: *

Organization:

Please include this if you know it.

Job Title:

Please include this if you know it.

Award Category: *

Reason for Nomination: *

Please explain in 250 - 500 words why this person should be considered for an award.

(If you're a human, don't change the following field)

Enter your name:

Your first name.

By submitting this form, you accept the Mollom privacy policy.