AFRICAN PEACE MAGAZINE AWARDS NOMINATION FORM

DESIGNATION *

Mr.Mrs.Dr.ChiefHonourableSenator

Full Name *

BRIEF PROFILE

SEX *

MALEFEMALE

Email *

Phone Number *

Address

Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

NOTARY PUBLIC

HUHANITARIAN SERVICE *

SUPPORT BUDGET *

NAME OF NOMINATOR/SPONSOR

ADDRESS OF NOMINATOR/SPONSOR

Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

ATTACH PASSPORT *

ATTACH SUPPORT DOCUMENTS & VIDOES (A)

ATTACH SUPPORT DOCUMENTS & VIDOES (B)

Date of Completing this form - Use todays date *

I verify that information given here are true *

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