Name ________________________________________

Address ______________________________________

______________________________________

______________________________________

e-mail     ______________________________________

Phone    ______________________________________

Birth date _____________________________________

Where article(s)

were published _________________________________

_____________________________________

_____________________________________

Publication dates ________________________________

______________________________________

Send to:

Clark/Payne Award

National Press Foundation

1211 Connecticut Ave.

Suite 310

Washington, DC 20036

All applications must be received by June 30, 2008