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Distinguished Member of the House Award

Presented in recognition of the unique or exemplary service to the House through committee work. Chairing of committees and service as an officer will be considered, but not required. Annual presentation is not required and there shall be no limitation of the number of annual recipients.

Restrictions:

• To be given only to recognize persons for their service to the House of Delegates.
• Only a person who has served as a Delegate within the previous five (5) years may receive this award.
• No member of the HoD Honors and Awards Committee is eligible to receive this award while serving on that Committee.
• No AAPG member shall receive more than one House award in any one year.
• No candidate for an HoD or AAPG office can be nominated for an HoD award in the same year.

The following form will email the information you provide to AAPG Headquarters. If you would prefer you may download these forms and send them to AAPG's headquarters:

• PDF form: Download this PDF (81k) and use your computer to fill out the data fields. Print and send to AAPG. This information will not save to your computer.
• PDF print: Download this PDF(64k) and print this form then fill out the data before sending it to AAPG.

Nomination Form:

I would like to nominate the following to receive the Distinguished Member award from AAPG's House of Delegates:

Current Year
Nominee's Name
AAPG Affiliated Society or Region

Service record to the AAPG House of Delegates:

HoD Committee Participation

Committee	Term (e.g. 2001-2002)
1.
2.
3.
4.

HoD Committee Chair

Committee Chaired	Term (e.g. 2001-2002)
1.
2.
3.
4.

HoD Offices Held

Office	Term (e.g. 2001-2002)
1.
2.
3.

HoD delegate terms served

Term (e.g. 2001-2002)	Total years of service as delegate:
1.
2.
3.
4.
5.
6.

Term(s) of service as local HoD Foreman or Group Chairman:

Additional comments or support material:

Submitted by: *

I am affiliated with AAPG Society / Region

Contact information:

Phone: *

Fax:

Email: *

Submit before September 30

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Please enter the above text exactly in the field provided below to validate this submission.