Name and Number of Character: _______________________________ (From List)

Date of Birth: ____________ Date of Death (when applicable): ________________

Photo Available? YES NO Photo Attached? YES NO

Anecdote (not to exceed 250 words):

I don’t have a story. I want to nominate ___________________________ for List Two.
(Nominations will only be accepted with full information filled in below by nominator.).

Name of Author: _______________________________________

Address: _______________________________________

Town/State/Zip _______________________________________

Telephone: _____________________ E-Mail Address: ______________________

By submitting this story to the Aspen Historical Society, I hereby give my permission for this work to be used in exhibits and to become a permanent entry in the archives at AHS.