2009 Summit Awards Nomination Form

The Amy Hertz Award will be presented to an individual or organization exemplifying outstanding advocacy and education in smokeless tobacco prevention and control. The award was named in honor of Ms. Hertz, the Deputy Attorney General for the State of California and an expert on the Smokeless Tobacco Master Settlement Agreement. She shared her knowledge and expertise with tobacco prevention advocates around the nation before her death in February 2007.

The Buck Tobacco Sponsorship Award will be presented to an individual or organization that has worked to eliminate or restrict smokeless tobacco sponsorship in their community. This award was inspired by the work of the Buck Tobacco Sponsorship Project, which started in California in 2002 and moved to the national level in 2005. The program has spearheaded education, advocacy, and policy change related to smokeless tobacco sponsorship of rodeos.

The Through With Chew Policy Award will be presented to an individual or entity showing excellence in policy change specific to smokeless tobacco. The award was influenced by the American Academy of Otolaryngology (which coined the term "through with chew" and initiated the first TWC awareness week) and the work of the Wyoming Through With Chew (WTWC) program. WTWC began as a small innovative pilot project in Jackson, Wyoming, and is currently a statewide coordination program operating with a comprehensive, population-based plan. WTWC provides training and technical assistance in policy development and implementation related to smokeless tobacco issues.

Nominator Contact Information

Name of Person Submitting the Nomination: (Required)

Your E-Mail Address: (Required)

Your Phone Number: (Required)

Which Award is the Person/Organization Being Nominated For? (Required)

The Amy Hertz Award
The Buck Tobacco Sponsorship Award
The Through With Chew Policy award

Nomination Information

Nominated Person/Organization's Name: (Required)

Nominated Person/Organization's Phone: (Required)

Nominated Person/Organization's E-mail: (Required)

Short Description of the Person/Organization: (Required)

Tell us why this person/organization should receive the award: (250 words or less) (Required)

Please provide three (3) references for the above person/organization to verify the accomplishments listed above:

Reference #1

Reference #1 Name: (Required)

Reference #1 Phone: (Required)

Reference #1 E-mail: (Required)

Reference #2

Reference #2 Name: (Required)

Reference #2 Phone: (Required)

Reference #2 E-mail: (Required)

Reference #3

Reference #3 Name: (Required)

Reference #3 Phone: (Required)

Reference #3 E-mail: (Required)

Attachments or Links

You may also add optional links to or attachments of newsletters, newspaper articles, etc. to support above person/organization’s accomplishments as an additional reference for the nomination.

Link #1:

Link #2:

Link #3:

Attachment #1:

Attachment #2:

Attachment #3:

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2009 Summit Awards Nomination Form