AIPG National Awards Nomination Form
National awards include the Ben H. Parker Memorial Medal, the Martin Van Couvering Memorial Award, the John T. Galey, Sr. Memorial Public Service Award, Honorary Membership, Outstanding Achievement Award and the Presidential Certificate of Merit.

The qualifications for these awards can be found at

DEADLINE: Completed nominations must be received by January 15, 2018.

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Nominee Name *
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Nominee Contact Information (address, phone, and email) *
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Please use the space below to describe your reasons for this nomination. Be as detailed as possible. Supporting documentation can be sent to *
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Nominated by *
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Nominators contact information (address, phone and email) *
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