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Name <br />Title <br />Organization <br />Address <br />City <br />State <br />Zip <br />Phone <br />Fax <br />E -mail <br />Name <br />Title <br />Organization <br />Address <br />City <br />State <br />Zip <br />Phone <br />Fax <br />E -mail <br />Two persons designated to <br />receive the award at the presentation ceremony: <br />Name <br />Title <br />Organization <br />Address <br />City <br />State <br />Zip <br />Phone <br />Fax <br />E -mail <br />Name <br />Title <br />Organization <br />Address <br />City <br />State <br />Zip <br />Phone <br />Fax <br />E -mail <br />RELEASE AUTHORIZATION <br />The undersigned gives the ACHP and the PreserveAmerica Presidential Award program [PreserveAmerica] <br />absolute right to use and distribute, in whole and in part, all material submitted in furtherance of this <br />nomination. All submitted materials become the property of PreserveAmerica and will not be returned. <br />Materials may be used in program activities, including publications and Web sites. PreserveAmerica is <br />given permission to make any editorial changes and/or additions to subject material. The undersigned <br />guarantees to have on file all necessary individual agreements and signatures to ensure PreserveAmerica <br />unencumbered use of all associated material. <br />Release authorized by: <br />Title <br />Signature Date <br />PRESERVE AMERICA PRESIDENTIAL AWARD 2007 NOMINATION <br />