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1999 National Environmental Achievement Awards

Nomination Application

Individual Achievement

Name of Nominee:

 

Title:

 

Address:

 

Phone Number:

 

Member Achievement

Project/Program Name:

 

Agency Name:

 

Address:

 

Phone Number:

 

Nominator Information

Person Submitting Nomination:

 

Title:

 

Agency:

 

Address:

 

Phone Number:

 

Agency Representative to AMSA:

 

Representative’s Signature:

 

Chief Elected Officials

The following is to be completed for Member Agency Achievement Award Nominations Only

Local Chief Elected Official (e.g., Mayor, Governor):

 

Title:

 

Address:

 

Federal Chief Elected Official (e.g., Senator):

 

Title:

 

Address:

 

Federal Chief Elected Official (e.g., Representative)

 

Title:

 

Address:

 

Please return with summary overview by December 18, 1998,
attn: Sharon Powell
AMSA
1000 Connecticut Avenue, NW, Suite 410
Washington, DC 20036

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