End Abuse Long Beach
CHILD ABUSE & DOMESTIC VIOLENCE PREVENTION COUNCIL
P.O. BOX 1548, LONG BEACH, CA 90801-1548
Since 1975
www.EndAbuseLB.org

ANNUAL AWARD NOMINATION FORM 2008

Child Protection & Domestic Violence Prevention

Each December, End Abuse Long Beach honors community members for their outstanding contributions in the prevention of domestic violence, child abuse, sexual assault, elder abuse, substance abuse or other related issues.
To make a nomination, please complete as follows:

Your Nominee:

First Name:    Last:
Street:
City:    State     Zip:
Specify reason for nomination:

Your Information:

First Name:    Last Name:
Street:
City:   State:   Zip:
Phone:
E-Mail:

Deadline for submissions to be considered: September 11. 2008

Please fill in, print, sign, and mail to: End Abuse Long Beach, P.O. Box 1548, Long Beach, CA 90801

SIGNATURE: ___________________________ DATE: _________________