ALA/ALTA NATIONAL ADVOCACY HONOR ROLL NOTIFICATION
FORM FOR RECOGNITION OF ADVOCATES
State Library directors are asked to submit up to three notification forms for the state’s selected honorees. These forms are available on the ALTA website at www.ala.org/alta.
Please submit all forms by April 15, 2005to Kerry Ward, ALTA Executive Director, (kward@ala.org). If you are unable to submit the forms electronically, you may mail the forms to Kerry Ward, ALA/ALTA, 50 East Huron Street, Chicago, IL 60611 (FAX: 312-280-3256). If you have questions, please call the ALTA office at 800-545-2433, ext. 2161.
State Library Agency: _____________________________________________________
Contact at State Library for questions:
Name: __________________________________________ Email: ________________________________
Address:
Street City State Zip
Telephone: _________________________________ Fax: __________________________
Name of Honoree (Individual or Group):
Name:
(as it should appear in print)
Address:
Street City State Zip
Telephone: ____________________________________
Fax: _______________________________ Email address: ________________________________
Select one “community” from the list below that best represents the affiliation of the honoree:
____ Library Community ____ Business and Professional Community
____ Political and Public Service Community ____ Philanthropic Community
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