PADESTA with PSOA Awards Nomination Form
Please check the award for which you are nominating a candidate. If you wish to nominate more than one
individual, you may photocopy this form.
Name of Nominee: ____________________________________________________________ Professional position:___________________________________________________________ Nominee's address:____________________________________________________________ Home telephone:_______________________ Work telephone:__________________________ Nominee e-mail:__________________________________________ PLEASE NOTE! NOMINEE (except candidate for Distinguished Service Awards) MUST BE A MEMBER OF ASTA! Name of Nominator: ____________________________________________________________ Address of Nominator:____________________________________________________________ Home telephone:_______________________ Work telephone:__________________________ Nominee e-mail:__________________________________________ Are you a member of ASTA with NSOA? ________Yes ______No (if not a member, please state relationship to nominee). In the space provided below, please indicate briefly why you believe this person or business deserves the award for which he/she is being nominated. You must include a brief summary of the nominee's accomplishments and achievements. Please return this form along with any supporting materials that you may wish to include to: Susan Basalik 324 Colonial Avenue CoKegcvtlle, PA 19426 sbasalik@chrsinc.com |