Friend of IEEE Member and Geographic Activities Award Nomination Form

   * = Required Field

1.* Nominee or Organization
    (If organization list primary contact)

2. *Address

 City State/Prov   
Postal Code

    Country

3 .Telephone Number
   Fax Number

   Email Address

4. How long has the candidate/organization provided service to Regional Activities?

5.*   How has the candidate or organization supported Regional Activities?

6.* Nominated by   
     Member Number

      Address

       City State/Prov   
       Postal Code

       Country

       Telephone Number
      Fax Number

       * Email Address

7.    Endorsed by                                                  

    1) Name    
       Member Number

    2) Name    
       Member Number

    3) Name    
       Member Number

    4) Name    
        Member Number

    5) Name    
       Member Number

8. *Suggested Citation

9. The award should consist of (select one)  Plaque     Certificate

      Date Submitted
                                          DD-MM-YYYY

To be nominated for a Supporting Friend Award, the candidate should have a long (minimum one full year) history providing support to the IEEE. Specific examples of support are required: generalized and unsupported statements will not be sufficient. Supporting awards may be made for truly extraordinary examples of singular events, for example, assistance provided to host and IEEE conference or meeting.

To be nominated for a Sustained Friend Award, the candidate or organization should have a long (minimum of three years) history of demonstrating their support to Member and Geographic Activities. The candidate or organization must have won a Supporting Award at least once during this period. Sustaining Friend awards are not given for singular events.

The MGA Awards and Recognition Committee reserves the right to consider any nomination for awards other than the award suggested when, in its opinion, the support and justification may more appropriately apply to other MGA Awards.

  * Sender's Email Address
         * = Required Field