NEIL PASSARIELLO MEMORIAL AWARD

The Neil Passariello Memorial Award is given to an individual who has made distinguished contributions in the treatment of HIV/AIDS or in the field of HIV/AIDS in general psychodrama or in the spirit of Neil’s work and interests. The recipient is invited to present the Neil Passariello Invitational Workshop at the annual conference.

Name of Nominee______________________________________________________________

Address_______________________________________________________________________

City____________________________ State____________ Zip_______________

Phone ______________________________________ FAX ______________________________

E-mail _____________________________________________

In narrative form on a separate sheet, please describe the nominee's outstanding work in the field of HIV/AIDS, stating how their work has significantly contributed to the field and/or honors that of Neil Passariello.

Signature of Nominator (may be self-nomination) ______________________________________

Address_______________________________________________________________________

City____________________________ State____________ Zip_______________

Phone ______________________________________ FAX _______________________

E-mail address__________________________________________

Nominations must be postmarked no later than:

August 1

Please mail this form to the national office:

American Society of Group Psychotherapy and Psychodrama

301 N. Harrison Street Suite 508 Princeton, NJ 08540