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Burbank Voices
Nomination Form
The program “Burbank Voices: Then and
Now” airs on channel 6, the government access station for the City of Burbank. Anyone can nominee anyone
to tell their story on this program, but the selection process will favor those who are extraordinary
or unique in some way, or who are an eyewitness to some extraordinary
event. The final selection of nominees will be made by the Public
Information Office Subcommittee. The
Subcommittee consists of two City Council Members and the City Manager
and Assistant City Manager. It
is anticipated that far more people will apply than can be selected.
Everyone nominating someone can expect a response back from the
city. Thank you for
participating in this process.
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| 1. Who are you
nominating? (It is ok
to nominate yourself) |
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| 2.
Your name and contact information: |
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Address: |
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Phone: |
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| Alternate
phone: |
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| E-mail: |
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| 3.
Contact Information on nominee (as much as you know) |
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Address: |
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| Phone: |
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| Alternate
Phone: |
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E-mail: |
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| Age of
nominee: (Approximation
is okay) |
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| 4.
Does nominee have any physical limitations? |
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| 5.
What is special or unique about your nominee? (One or two
paragraphs is ok) |
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| 6.
Does nominee have any unique visual aids?
Please specify. (Such as photos, films, tapes, awards, art
work, diary, letters, collections, memorabilia, etc) |
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If you have any specific questions you may call
Michael McManus, the Public Information Officer for the City of
Burbank
, at
(818) 238-5849. Please
return this form to: Michael
McManus, Public Information Officer,
Burbank
City
Hall
, 275 E. Olive Avenue,
Burbank, CA 91502, or by e-mail to MMcmanus@ci.burbank.ca.us
or fax the form to (818) 238-5839.
Printable
Word version of form
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