Kemish Award Nomination Form

KEMISH AWARD NOMINATION FORM
The nomination is to reach the Association Secretary by 15th March

Nominee Information
From*

First NameLast Name
MemberHonorary
Membership Start Date*

MonthDayYear
Current Role/Position (if applicable)
Nominator Information
From*

First NameLast Name
MemberHonorary
Relationship to Nominee:
Current Role/Position (if applicable) and Signature
Signature*
Nominee’s Contributions: (Please provide detailed information about the nominee’s contributions to the Association,including but not limited to leadership, service, innovation, mentorship, impact or any other significant or noteworthycontribution – use additional sheet if required)*
Date

MonthDayYear
Supporting Nominator Information
From*

First NameLast Name
MemberHonorary
Relationship to Nominee:
Current Role/Position (if applicable) and Signature
Signature*
Nominee’s Contributions: (Please provide detailed information about the nominee’s contributions to the Association,including but not limited to leadership, service, innovation, mentorship, impact or any other significant or noteworthycontribution – use additional sheet if required)*
Date

MonthDayYear
Should be Empty:

KEMISH AWARD NOMINATION FORM