CLICK HERE to download a copy of this form for emailing


Copy and paste this application into an email to the email address listed below
and it will go DIRECTLY to ALL the panel members for review and research. Or you can click the PDF Download button below as well. 
Thank you and Good Luck!

NOMINEE'S GIVEN NAME:_________________________________________________


NOMINEE'S CONTACT INFO: ADDRESS___________________________________________________________

CITY:_________________________ STATE:_________________ ZIP:___________

PHONE  NUMBER:____________________________________________________

EMAIL ADDRESS:_____________________________________________________

(Needed if Nominee wins for cash award and other prizes)

Fetish/Leather name( if any):______________________________________________

Community Affiliation: please state

Club Affiliations (if applicable):____________________________________________

If Titleholder, Title and Year:______________________________________________

DESCRIBE PUBLIC SERVICE IN DETAIL!  NOTE: a MINIMUM of FIVE (5) YEARS for the yearly award; TEN (10) YEARS for Lifetime Award. ALL CLAIMS will be researched as best as possible by the panel to document its validity toward the award.






Your name:______________________________________________

Relation to Nominee:________________________________________

Date Submitted:___________________

DEADLINE: ALL Applications MUST be sent NO LATER than 11:59:59PM on May 30.
ANY applications received AFTER that date will be considered for the 
following year's award.

PLEASE answer ALL questions COMPLETELY and then send in an email to:

Copy and paste this application in an email to the above address and it will go
DIRECTLY to ALL the panel members for review and research. Thank you and Good luck!