Science Communication Awards – Entry Form

Fields marked with an * are required.

Check the category for which you are entering: *

Science Writing
Writing for Children
New Media

Author's Information:

Name: *

Address: *

E-mail: *

Phone: *

Title of Entry: *

Publication/Air Date: *

URL (if applicable):

Check box if submitting multiple entries as a "series"

URL:

Publisher's Information:

Name of Publishing House
(or magazine, station, etc):
*

Address: *

Name/Title of Contact:

Contact Email: *

Contact Phone:

Name of person submitting/
nominating entry:
*

Email address to which entry
confirmation should be sent:
*

Check box if author has been informed of his/her nomination

Additional comments:

(For Web materials: If your work is part of a larger Web presence, please clearly define the extent of your submission.)

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