Medallion Nomination

AFGC 2018 Medallion Nomination Form
Deadline: October 15, 2017


Nominee's Name:
Nominee's State Council Affiliation:
Nominee's Title:
Nominee's Mailing Address:
Nominee's Telephone Number:
Nominee's Email Address:
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:
By entering my name below, I acknowledge that the content in this form is accurate to the best of my knowledge. :

PO Box 867, Berea, KY 40403