Award Nomination

Nominee *

Salutation, First Name, Last Name, Credentials

Membership *

Yes

No

Don't Know

Is the nominee a current member of NuXi at large?

Contact Information

How can this person be contacted? (Please include any known addresses, phone numbers, email addresses, etc.):

Award

Please choose a category.

Contributions *

Describe the contributions of the candidate related to the selected category:

Impact *

Describe the impact or significance of the contribution:

Reason

Describe why you believe this candidate should receive this award:

Nominator *

Salutation, First Name, Last Name, Credentials

Relationship *

Please describe your relationship to this nominee (ie - how long and in what capacity you have worked with this candidate) :

Contact *

Tell us how we can contact you (Please include any known addresses, phone numbers, email addresses, etc.):

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