NOMINEE INFORMATION

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* 1. Nominee Name

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* 2. Nominee Title

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* 3. Nominee Institution

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* 4. Nominee Address

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* 5. Nominee Phone

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* 6. Nominee Email

NOMINATOR INFORMATION

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* 7. Nominator Name

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* 8. Nominator Title

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* 9. Nominator Institution

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* 10. Nominator Address

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* 11. Nominator Phone

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* 12. Nominator Email

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* 13. Please describe why you feel this individual is deserving of induction into the ICLA Hall of Fame

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