Nomination Form (Deadline date:  extended to Feb. 28, 2018)

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* 1. Nominee

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* 2. The nominee is a:

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* 3. Nominee's Organization:

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* 4. Nominee's years with organization:

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* 5. Nominee's title:

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* 6. What is your name and work title?

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* 7. Your phone number:

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* 8. Your email address:

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* 9. Describe the specific contribution / accomplishments of the nominee:

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* 10. Why was this contribution and/or accomplishment important and what impact did it make? 

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* 11. Are there other contributions, past awards received or anything else about the nominee we should know?

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