2019 Annual Salute to Black Mothers Church Honorees Information Form
Greetings. The Concerned Black Clergy of Metro Atlanta would like for your church/mosque/temple/religious organization to fill out this form with the names of your women honorees. There are 3 categories. Please provide one name for each category. Each person’s name will be listed in the program and they will receive special recognition at the luncheon. Please submit all nominations by October 9, 2019 for printing in the program.

PLEASE NOTE: Your organization is responsible for purchasing tickets for those you are recognizing. Individual tickets are $50.00; a table for ten is $500.00.
Name of Church/Mosque/Temple/Religious Organization *
Your answer
Name of Pastor/Lead (with title) *
Your answer
Contact Person *
Your answer
Contact Email
Your answer
Phone Number *
Your answer
Woman of the Year *
Your answer
Young Women of the Year *
Your answer
Overcoming Women of the Year *
Your answer
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