THE CHARLES A. AND ANNE MORROW LINDBERGH FOUNDATION

LINDBERGH AWARD

Nomination Form

Nominee:

Title and Affiliation:

Address:

Telephone:

State how the life and work of the nominee have made significant contributions to a balance between technological advancement and environmental preservation. (If this space is not adequate, please use an additional page; or, if you prefer, your statement may be included as part of the executive summary.)

Nominator:

Title & Affiliation:

Address:

Telephone:

Please return this form, your executive summary, seconding letter(s), and supplementary materials by April 1, 2005, to the Lindbergh Foundation, 2150 Third Avenue North, Suite 310, Anoka, MN 55303-2200. Phone: 763/576-1596.