IACR 2001 Election Nomination Form

Section 1 --- to be completed by nominator ---

Nominator:

__________________________________________	__________________________________________
Name (print)	Signature
__________________________________________	__________________________________________
Date	Address
__________________________________________	__________________________________________
Email	Address
__________________________________________	__________________________________________
Fax	Address

Section 2 --- to be completed by nominee ---

Candidate's statement (max. 50 words, may also be sent by email):
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

Optional items to appear only in the electronic version of candidate statements:

• URL for longer candidate statement http://__________________________________________________
• URL for candidate home page http://__________________________________________________

This form must be received by mail or fax by September 16, 2001 at the address below. Receipt will be acknowledged by email.

Tom Berson
Anagram Laboratories
P.O. Box 791
Palo Alto, CA 94302, USA
Fax: +1 650 324 0120