The Herblock Prize

ENTRY FORM

We agree that the material submitted with this entry form becomes the property of the Herb Block Foundation and may be used to publicize the awards program or collected in educational and/or research archives for other educational purposes. We certify that this entry was published as presented in 2010.

NAME & ADDRESS

OF NEWSPAPER OR

MAGAZINE

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PHONE____________________________________________________

E-MAIL____________________________________________________

SPONSOR LETTER SIGNED BY (May Self Sponsor)        

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Name

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Title

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E-Mail / Fax Number

Please mail entries to:

The Herb Block Foundation

1730 M Street, NW

Suite # 901

Washington, DC 20036