NOMINATION FORM for FAB 5 Recognition 2017

Do you Know Someone Special?

5 nominees will be selected and receive a one-year complementary membership in CAUCUS. One of the 5 will be selected to have his/her expenses (airfare, lodging, food, and registration fee) paid for CAUCUS ITPS 2017. Nominations are due no later than Friday, September 8, 2017.

Question Title

* 1. NOMINEE

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 2. PERSON SUBMITTING NOMINATION

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 3. Provide brief summary of Nominee’s contributions/achievements in IT procurement citing examples demonstrating initiative, collaboration, innovation and/or leadership.

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* 4. What characteristics do you believe make this Nominee extraordinary?

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* 5. Is there anything else that you would like to share with us about this Nominee (or you if you are self-nominated)?

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* 6. Is the Nominee a Member of CAUCUS? (can still be nominated even if not a Member of CAUCUS)

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* 7. What other professional organizations, if any (PMI, Bar Association, etc.) does Nominee belong to?

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* 8. By signing below, the person submitting this Nomination confirms the information provided herein is correct to the best of his/her knowledge, information and belief.

Signature (or type in name) of Submitter

Date Submitted

FINE PRINT: */ Eligibility is open to individuals who are legal residents of the fifty (50) United States (including District of Columbia) and Canada, and who are 18 years or older on date of award. Employees of ICN/CAUCUS, CEAC, ICS Board, and persons administering the program are excluded. Winners will be announced at ITPS 2016 and need not be present to win.