SPI South -- Distinguished Service Award Nomination Form

SOUTHERN REGION DISTINGUISHED SERVICE AWARD NOMINATION FORM

Submitter Information: Please provide all requested information.

Name:

Title:

Organization:

Mailing Address:

City:

State:

Zip:

Phone:

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Email:

Nominee Information: Please provide all requested information.

Name:

Title:

Organization:

Mailing Address:

City:

State:

Zip:

Phone:

Fax:

Email:

Please provide detailed examples of nominees outstanding service to the plastics industry. Some examples are: Active participation in plastics-related association activities, committees and boards; Plastics-related published papers, patents and/or technical advancements; and/or Community involvement initiatives to improve the image of plastics.