Please Complete and Submit a Copy of This Form with Your DVD S

Please complete and submit a copy of this form with your DVD’s

Authorized Submitter / Title
Company
Address (street, city, state, zip)
Phone / Fax / E-mail
Production Title
Network (and production company if co-produced with a network)
Premiere Date (Must be between January 1, 2010 – December 31, 2010)
Program Description - Please check category:
Documentary/Biographical Series or Special
Scripted Drama or Comedy Series or Special
Reality/Lifestyle Series or Special

Please describe why this production should be considered for a Signature Accolade, including how it best depicts women in multidimensional and authentic roles who have had a significant impact on past or current events and/or showcases women’s issues and advocacy. (If more space is needed please attach a separate sheet)

WICT may contact those submitting nominations for additional information.

All nomination forms and DVD’s must be received in the WICT offices by 5:00 p.m. ET, Friday, April 15, 2011. No exceptions to the deadline can be made.

Please mail submissions to: Kim Pugliese, Program Coordinator

WICT | 14555 Avion Parkway | Suite 250 | Chantilly, VA 20151

Questions? Please email: | phone: 703.234.9820 | fax: 703.817.1595