2005 Western States Wild Horse and Burro Expo
Hall of Fame Award
Nomination Entry Form

1. Name of person, horse or burro to be nominated.
(if horse or burro - please also provide owner/adopter's name)

2. Affiliation with organization or agency (if any).

3. Category of Nominee's contribution or achievement:
(select all that apply)

a. Adoption
b. Rescue
c. Training
d. Education
e. Fostering
f. Government Agency

g. Lobbyist
h. Program Management
i. Therapy Program
j. Youth Program
k. Other:
     

4. Briefly describe what outstanding contribution(s) the nominee has made to improve or promote wild horse and burro programs.

5. Give two examples of how the nominee has shown dedication and commitment to wild horse and burro program(s).

6. Describe any extraordinary challenges the nominee has overcome in his/her work with wild horse and burro programs.

7. How long has the nominee been involved in his/her work with wild horse and burro programs?

8. If nominee is selected for an award will he/she be able to attend the WSWHBE, August 21, 2005 in Reno, Nevada to receive their award in person?

 Yes
No

9. Individual making nomination:

Name:
Address:
Phone:
Fax:
Email:
Relationship to nominee:

Deadline for entries is June 30, 2005
Nominees will be notified of their entry via email
Inductees will be chosen by majority vote of the WSWHBE Committee
Award winners will be contacted prior to event
Inductees will be awarded with a beautifully engraved plaque presented August 21, 2005 at the Western States Wild Horse and Burro Expo, Reno, Nevada