Archie League Medal of Safety Award Nomination

Archie League Medal of Safety Awards Nomination Form
Nominator Information
Nominator Name*

First NameLast Name
Nominator Facility*
NATCA Member*

YesNo
Email*
Phone Number*

Area CodePhone Number
Nominee Information
Nominee Name*

First NameLast Name
Facility*
Region*
NATCA Member*

YesNo
Team Members
Enter names of all members of the team, if applicable.
Pilot Details

Please include as many details as possible.
Pilot Name (If Known)

First NameLast Name
Aircraft ID(s)
Aircraft Type(s)
E-mail (If Known)
Phone Number (If Known)

Area CodePhone Number
Event Details
Date of Event*

MonthDayYear
Time of Event (approximate)

:HourMinutesAM/PM Option
Was an emergency declared?*

YesNo
Type of Incident*

VFR Aircraft in IMCIcingAircraft Mechanical MalfunctionCommunication MalfunctionRunway IncursionStudent PilotLimited Experience PilotsAircraft AccidentMilitary OperationsMedicalATC Facility IssueOther
Description of Event*
Please include as much detail as possible. You may also attach a document below, if desired.
Supporting Documentation

Please submit as much information as possible. Upon submission an email will be sent containing a link to upload additional documentation, as necessary.
Falcon Link
Link to bookmarked event on Falcon
Additional Information

Upload a File
News coverage, pilot letters, etc. Cancelof
Radar and Audio Recordings

Upload a File

Cancelof
After submission, you will be redirected to a confirmation screen and will receive a confirmation email. If you experience any issues or have any questions send an email to archie-submissions@natca.org for assistance.
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Archie League Medal of Safety Awards Nomination Form