PLEASE NOTE: Deadline for nominations is Friday, March 1, 2019.
It is not necessary to fill in all of the spaces on this form; only the ones you need.
Questions: Contact Michael van der Gaag at (585) 414-0526 or email@example.com.
Please select one award category.
If you want to nominate more than one candidate for the same award, there will be an opportunity to do so after you submit this ballot.