Deadline for Submission:  December 1, 2021

Confidentiality Statement:  The information provided in this Nominating Form will be used solely for the purposes of evaluating nominations for the David L. Hadler Risk Management Award.  Copies of this nomination form will only be made available to the review panel consisting of the EIM Board of Directors, Insurance Advisory Committee and EIM senior executives.  No additional access, or further distribution of the information contained in this form will be undertaken.

Any questions about the nomination form can be directed to Jill Dominguez at jdominguez@eimltd.com.

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* 1. Contact Information

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* 2. Briefly outline what best exemplifies the Nominee’s professionalism and excellence in the energy industry.

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* 3. Provide an overview of the Nominee’s dedication to the energy industry, including but not limited to his/her contributions to advancing risk management techniques, strategies or solutions within the energy industry.

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* 4. How has the nominee served as a mentor to others in the industry or those interested in entering the Insurance and Risk Management Profession? (include service on committees of other Mutuals, RIMS involvement, colleges or universities)

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* 5. What other aspects of this nominees personality, professionalism and/or contribution uniquely qualify them for the David L. Hadler Risk Management Award? (Optional)

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