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Name:
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Address of applicant [please print]:
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Brief description of the entry:
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City/post-town:
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Postcode:
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Telephone:
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Fax:
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Email:
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Course/media organisation:
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Lecturer/editor name [please print]:
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Lecturer/editor signature:
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Date of publication/transmission:
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Applicant signature:
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A copy of the published original or broadcast item must be submitted with this application by January 24th 2001 and sent to:
Felix Dearden Memorial Prize, National Union of Journalists, Acorn House, 314 Grays Inn Road, London WC1X 8DP
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