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Keyperson of the Year Award: Persons nominated for this award shall be optometrists, members of the Nebraska Optometric Association, who, during the past year; have helped advance the Association's advocacy efforts through effective involvement in political or regulatory affairs on behalf of optometry. Please describe below how the nominee has demonstrated commitment in the areas below.

The award will be presented at the NOA Fall Convention and the recipient will be notified in advance.

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* 1. Nominee's Information:

Name of Nominee:

Practice:

Address:

City/Town:

State:

ZIP:

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* 2. Developed and maintained a productive relationship with their senator:

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* 3. Supported NOA PAC with personal contributions and encourage other optometrists to contribute:

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* 4. Informed & educated their legislator about optometry's legislative goals through regular visits and correspondence:

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* 5. Actively participated in political activities:
(fundraising, organization, signs, letters, etc.)

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* 6. Person submitting nomination:

Name:

Email Address:

Phone Number:

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* 1. Nominee's Information:

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* 2. Developed and maintained a productive relationship with their senator:

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* 3. Supported NOA PAC with personal contributions and encourage other optometrists to contribute:

Question Title

* 4. Informed & educated their legislator about optometry's legislative goals through regular visits and correspondence:

Question Title

* 5. Actively participated in political activities:(fundraising, organization, signs, letters, etc.)

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* 6. Person submitting nomination:

* 5. Actively participated in political activities:
(fundraising, organization, signs, letters, etc.)