Please completely fill out the form below and we will process your nomination as soon as possible. Thank you in advance for your submission.

Name of Nominee:

Address:

City:

Nominator's Phone:

Nominator's Email:

Subject aid is used in teaching:

Description of training aid:

Cost of constructing aid:

Location(s) of class where aid has been used:

Describe way aid is used in training class:

Will aid be available for our next conference? YES NO

I, hereby certify that all statements on this (Person making nomination) Application is true.

Nominee must be an active member of the Society

Please return to Awards Chairman or Society Office no later than the end of January.