IWIRC 2023 Melnik Award Nomination Form

IWIRC 2023 Melnik Award Nomination Form

Due May 31, 2023
The Melnik Award, named for IWIRC founding Chair Selinda Melnik, is awarded to a member whose contributions to IWIRC, over an extended period of time, have been exceptional. By her efforts, she has made a lasting impact on the mission of IWIRC.
Nominator *

First Name Last Name
Nominator E-mail *
Nominee *

First Name Last Name
Nominee E-mail *
example@example.com
Nominee's Network *
No. of Years as an IWIRC member *
IWIRC Network positions held: please describe and list years *
IWIRC national positions held: please describe and list years *
IWIRC Regional positions held: please describe and list years *
IWIRC International positions held: please describe and list years *
Lasting and exceptional contributions to IWIRC: please describe. *
I note that the nominee is a member in good standing. (To verify, please go to the IWIRC website and check their profile. If you are not able to see their profile, their membership is not current.)

Yes Np
I authorize that IWIRC may use any of the statements above, with or without accreditation, inany press release or other public notification if the nominee is selected.

Yes No
Date *

Month Day Year
Date
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