Committee Member Award

Submissions due by August 31

The Committee Member Award is presented to a member who has been active on one or more committees in the NCVPRN Joint Affiliate/AACVPR. This person takes on additional responsibilities within the network by completing their assignments, regular attendance at meetings &/or teleconferences, attending NCVPRN Conferences, and being willing to take on tasks that help promote the work of NCVPRN. They may have served either as a committee member or chairman of a committee, during which time they remain committed to excellence in their work and follow the bylaws of NCVPRN.

Question Title

* 1. Name of Nominee

Question Title

* 2. Nominee Employer

Question Title

* 3. Nominee Address:

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

Question Title

* 4. Nominee Position:

Question Title

* 5. Nominee Contributions to the NCVPRN

Question Title

* 6. Nomination by:

Name

Date:

Email:

Phone: