Distinguished Service Award Application

Please complete the following information about the nominee:

Miss Mrs. Mr. Dr. Other Name:
Address:
City, State, Zip:
Phone (area code and number):
Current Position (if applicable):

Please complete the following information about yourself:

Miss Mrs. Mr. Dr. Other Name:
Address:
City, State, Zip:
Phone (area code and number):

Using the criteria from the Selections Procedure page, please explain why you think the nominee should receive the IAGC Distinguished Service Award. An attached page can be used if a larger space is required.

Submit the completed application to:

IAGC Recognition Committee
Attention: Nancy Heaton
800 E. Northwest Highway, Suite 610
Palatine, IL 60074

Deadline for application is November 1.