Emeritus Recognition Form

Emeritus Recognition Form
Email any backup information to:

awards@nnecapa.org Subject Line: Emeritus Award Nomination
Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email
example@example.com
Employment History: Please list your employment starting with your most recent position. (Example: Senior Planner, Anytown, ME 2000-2019)
Education: Please list educational degrees (Example: University of x, BA, 1980)
Words of Wisdom...biggest lesson you learned during your career that you would like to share with other planners. (Optional)
Retiree Information: I certify that I am or was a member of the NNECAPA Chapter of APA

Yes, I am a member of NNECAPA Yes, I was a member of NNECAPA No, I have never been a member of NNECAPA
Recognition will be at the annual NNECAPA Conference. For more information please visit www.nne.planning.org/awards or email: awards@nnecapa.org.
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