Archie League Medal of Safety Award Nomination

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

First Name Last Name
Nominator Facility *
NATCA Member *

Yes No
Email *
Phone Number *

Area Code Phone Number
Nominee Information
Nominee Name *

First Name Last Name
Facility *
Region *
NATCA Member *

Yes No
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 Name Last Name
Aircraft ID(s)
Aircraft Type(s)
E-mail (If Known)
Phone Number (If Known)

Area Code Phone Number
Event Details
Date of Event *

Month Day Year
Time of Event (approximate)

: Hour Minutes AM/PM Option
Was an emergency declared? *

Yes No
Type of Incident *

VFR Aircraft in IMC Icing Aircraft Mechanical Malfunction Communication Malfunction Runway Incursion Student Pilot Limited Experience Pilots Aircraft Accident Military Operations Medical ATC Facility Issue
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.
Additional Information
News coverage, pilot letters, etc.
Radar and Audio Recordings
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.
Should be Empty:

Archie League Medal of Safety Awards Nomination Form