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P.O.W.E.R.S. Award Honorary Committee Participation

Participation Confirmation

To:  Program Director

Fax:  323-443-3545

Email: powers9@ix.netocm.com

From: __________________________________

Honorary Committee Member

RE:  15^th Annual P.O.W.E.R.S., Awards

          Honorary Committee Acceptance & Confirmation

_______________________________________, accepts your invitation to serve as an Honorary Committee member for the 15^th Annual P.O.W.E.R.S. Award.

 By accepting this invitation, I understand and give my permission as a Honorary Committee member for you to place my name on your letterhead and to include my name in your event souvenir journal.

Included on this form are t address, phone, fax and email where I can be reached most directly.  My bio and/or resume is included with this form.  I will send you a photograph under a separate cover if necessary.

Signed: _________________________________________________________________

For:  ______________________________________________ (if signed by a representative)

Address:_____________________________________________________________________

City/State:__________________________________________ Zip Code:________________

Phone:____________________________________  Fax:_____________________________

Email:______________________________________________________________________