Lutheran Historical Society of the Mid-Atlantic Site Recognition Nomination Form Name and address of site (required) Name, address, email, and phone number of owner or principal authority responsible for the site. (required) Name, address, email and telephone of person submitting this nomination and who the Site Committee can contact for further information and material (required) Is he or she a member of the Lutheran Historical Society of the Middle Atlantic? YesNo Is the owner/principal aware this site is being nominated? YesNo Is the owner/principal agreeable to the requirements for recognition, including the placement of the plaque, its formal presentation, and the grant for preservation of materials and publication of historical information about the site? YesNo A paragraph summarizing the reasons this site deserves historical recognition. (required) A chronology of the principal events in the site’s history. (required) List the synodical affiliation(s) of the site. (This is necessary for the Site Committee’s research in synodical proceedings and archives.) (required) List historical publications (e.g., histories, anniversary pamphlets) relating to the history of this site. How would the site use the $750 grant that accompanies LHS-MA site recognition? Please be specific. The general purpose of the grant is for the archival sound preservation of historical materials and/or for publication of historical information about the site. (required) To contact the Site Committee with questions or additional information email Phil Teigen: email@example.com.