Application For Consigliere's™ Award

A ny information collected on this form other than the "Nickname" and "Site Name" (which shall be shown along with the link back to the site) is strictly confidential and only for The Consigliere's™ records for notification to the applicant.

The Consigliere's™ Award Application

First and Last Name Your Nickname Street Address City, State & Zip Your Age (optional) Is Parent Or Guardian Filling Out Form Yes No Address Of The Site You Are Submitting Name Of Your Site Short Description Of Your Site 25 words or less Your e-mail address

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