AFGC 2023 Medallion Award Nomination Form

Deadline for Nominations: 11/1/2022

Nominee's Name *
Nominee's State Council Affiliation *
Nominee's Title *
Nominee's Mailing Address *
Nominee's Email Address *
Nominee's Telephone *
Nominee's Academic Degrees
Nominee's Employment History *
Nominee's Prominent Honors, Awards, or Other Recognitions Received
Please tell us why you feel this person is deserving of this award. *
Nominee's involvement in professional society memberships and major activities *
Nominee's Significant Publications
Nominee's List of Major Contributions to AFGC *
Please upload a bio for the Nominee in paragraph format. This will be used to recognize nominee.
Please upload a photograph of the Nominee
Nominator's Name *
Nominator's Telephone Number *
Nominator's Email Address *


Fields marked with * are required.

Your form submission WILL be encrypted using SSL to ensure your privacy.

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