AWARD NOMINATION

Deadline for nomination submission is February 01 of each year -

Awards are presented each April at the Annual Conference

Nomination For:

      ____  Robert Stripp Award (Lifetime Achievement)

      ____  Luann Acuncius Award (EMS Education)

Individual/Group/Institution Nominated:

      _________________________________________

Qualifications/Reason for Award Nomination:

      _________________________________________

      _________________________________________

      _________________________________________

      _________________________________________

      _________________________________________

Nomination Submitted By:

      Name:  ___________________________________

      Address: _________________________________

                        _________________________________

      Telephone:  _______________________________

      E-Mail: ___________________________________

Mail Nomination To:

Illinois Emergency Medical Technicians Association

Post Office Box 3151

Springfield, Illinois 62708

ATTENTION: Awards Committee