Created from: Applications & Forms

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=90 BGCOLOR="#006699" TEXT="#080000" background="063085a3.jpg"> <div> <FONT SIZE="6" COLOR="#FFCC66" FACE="Arial" ><B>   </B></FONT><FONT SIZE="6" COLOR="#FFCC33" FACE="Arial" ><B>   Illinois EMT Association</B></FONT><B>  </B><B>   |     </B><A HREF="index.htm" TARGET="_top" TITLE=" Illinois EMT Association"><U><B>Home</B></U></A></div> <bR> <div> </div> </td> </tr><tr> <td valign="top" width=210 BGCOLOR="#FFFFFF" TEXT="#080000" background="064d2e83.jpg"> <div> <IMG SRC="067b73c0.jpg" border=0 width="183" height="60" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <bR> <div> <B><U>BOARD OF DIRECTORS</U></B></div> <div> <B>Augie Bamonti</B></div> <div> <I><B>President</B></I></div> <div> <B>Tina Meadows</B></div> <div> <I><B>Vice President</B></I></div> <div> <B>Gene Ryan</B></div> <div> <I><B>Secretary</B></I></div> <div> <B>Alan Davis</B></div> <div> <I><B>Treasurer</B></I></div> <bR> <div> <B>Pamela Davis</B></div> <div> <B>Colleen Evans</B></div> <div> <B>Vicki Gallaher</B></div> <div> <B>Bret Jefferies</B></div> <div> <B>Joni Ann Jones</B></div> <div> <B>Rodney Porteus</B></div> <div> <B>Paul Rasch, Jr.</B></div> <div> <B>Susan Schlebach</B></div> <div> <B>Michael Weaver</B></div> <bR> <div> <B><U>NAEMT GOVERNOR</U></B></div> <div> <B>Augie Bamonti</B></div> <bR> <div> <B><U>LEGAL COUNSEL</U></B></div> <div> <B>Atty. William King</B></div> <bR> <div> <B><U>WEBMASTER</U></B></div> <div> <B>Paul Rasch, Jr.</B></div> </td> <td valign="top" height=390 BGCOLOR="#FFFFFF" TEXT="#080000" background="06507073.jpg"> <div> <IMG SRC="067b73c0.jpg" border=0 width="183" height="60" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> <B><U>AWARD NOMINATION</U></B></div> <div> <B>Deadline for nomination submission is February 01 of each year -</B></div> <div> <B>Awards are presented each April at the Annual Conference</B></div> <bR> <div> <B>Nomination For:</B></div> <div> <B>      ____  Robert Stripp Award (Lifetime Achievement)</B></div> <div> <B>      ____  Luann Acuncius Award (EMS Education)</B></div> <div> <B>Individual/Group/Institution Nominated:</B></div> <div> <B>      _________________________________________</B></div> <div> <B>Qualifications/Reason for Award Nomination:</B></div> <div> <B>      _________________________________________</B></div> <div> <B>      _________________________________________</B></div> <div> <B>      _________________________________________</B></div> <div> <B>      _________________________________________</B></div> <div> <B>      _________________________________________</B></div> <div> <B>Nomination Submitted By:</B></div> <div> <B>      Name:  ___________________________________</B></div> <div> <B>      Address: _________________________________</B></div> <div> <B>                        _________________________________</B></div> <div> <B>      Telephone:  _______________________________</B></div> <div> <B>      E-Mail: ___________________________________</B></div> <div> <I><B>Mail Nomination To:</B></I></div> <div> <B>Illinois Emergency Medical Technicians Association</B></div> <div> <B>Post Office Box 3151</B></div> <div> <B>Springfield, Illinois 62708</B></div> <div> <B>ATTENTION: Awards Committee</B></div> </td> </tr></table></body>