BLACK MARRIAGE DAY NOMINATION FORM
Marriage is an institution that is vital to our families, churches, communities and nation.
Take this opportunity to encourage a male and female couple that you feel exemplifies
the commitment and dedication it takes to enjoy healthy and happy families and
relationships.
Delta Sigma Theta Sorority, Incorporated and the Indiana Healthy Marriage and Family Coalition,
Inc.invites you and members of your church, community, agency and/or organization to participate in our
Black Marriage Day Celebration. Please complete the following registration information for Inspirational
Couples that are part of your congregation, family, agency, organization and/or community. The
committee will contact each couple nominated and inform them that they will be recognized.
We look forward to joining you in honoring them as examples of dedication and commitment to the
institution of marriage in Indiana. All of the Inspirational Couples will be recognized. One (1) couple will
be chosen from each category to be recognized as winners at the Indiana Black Marriage Day
Celebration on Sunday, March 22, 2015, Oasis of Hope Baptist Church, 1701 East 25th Street,
Indianapolis, IN 46218 from 4:00 pm – 6:00 pm.
You may nominate more than one (1) couple however, please complete a nomination form for each
couple you nominate. The following information is needed along with the nomination form attached* (feel
free to make copies of the form for additional couple nominations):
DEADLINE FOR NOMINATION SUBMISSIONS February 28, 2015
Your name (as contact person): ____________________________________________
Organization (if applicable): _______________________________________________
Address: ______________________________________________________________
______________________________________________________________________
*Email: _______________________________________________________________
*Please provide this information if possible
Primary Phone #: ___________________ Other Phone #: _______________________
Relationship to Nominees: ________________________________________________
Please attach this cover sheet to your nomination form(s) and send to the address below or
email to: [email protected]
P.O. Box 1364 | Indianapolis, IN 46206-1364
Email: [email protected] | Web: www.dstiac.org
* ALL FORMS NOT COMPLETED IN ITS ENTIRETY ARE SUBJECT FOR DISQUALIFICATION
Inspirational Couple
_________________________
(Couples’ last name)
_______________________ and ________________________
(Husband’s first name)
(Wife’s first name)
This couple is nominated for the (check only 1) Couple’s Wedding Date (MM DD YY)
□ Lasting Love Award- Recognizes couples married 50 years or longer
□ Going For The Gold Award-Recognizes couple married for 25-49 years
□ To Have And To Hold Award- Recognizes couples married 15-24 years
□ In It To Win It Award-Recognizes couples married for 6-14 years
□ Newlywed Award- Recognizes couples married 5 years or less
□ Blended Family Award- Recognizes couples that are married and raising children from previous relationships
□ Across the Generations Award- Recognizes couples that are raising their grandchildren
Please include the following information so that the couple can be notified of nomination:
Couple’s Mailing Address ___________________________________________________________
City _________________________ _________State_____________ Zip ______________________
*Email: ________________________________________@________________________________
*Please provide this information if possible
Primary Phone #: _______________________________ Other Phone #: ___________________________________
Tell us what you admire about this couple (NOTE: Couples will receive points toward being recognized as the
winning couple in the category they were nominated based on your submission. Please include a photo, if
mailing please be sure to place the couples name on the photo.):
Deadline – February 28
th
Please limit your response to 250 words or less.
(Cont. on back if needed)
SOMEONE ADMIRES YOUR MARRIAGE AND NOMINATED YOU FOR AN AWARD!
BLACK MARRIAGE DAY HALL OF FAME 2015
Please tell us more about your special relationship by answering a few questions.
How did you meet?
How long have you been married?___________________
Tell us something about your family.
Tell us something unique about your relationship.
Tell us about your most memorable moment.
Why is marriage important to you?