LOUISIANA CONFERENCE ON WATER SUPPLY, SEWERAGE, AND INDUSTRIAL WASTES, INC.

S.L. Perry Award

NOMINATION FORM

        The S.L. Perry Award will be presented as conditions warrant, but not more often than annually, in recognition of leadership of and distinguished service to the Louisiana Conference on Water Supply, Sewerage, and Industrial Wastes, Inc. over a period of several years.

    The purpose of honoring conference members with this award is to recognize outstanding contributions of time and effort and to encourage and inspire others to likewise serve the public good and the conference by seeking to advance the knowledge and achievements of its members.

Date:

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 1. Nomination submitted by:

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 2. Name of Nominee: 

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 3. Address:

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 4. Present Employer:

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 5. Title of Present Position:

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 6. Certification Status: Louisiana Classification:

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     Field:

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 7. Other Qualifications:

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 8. Education and Training:

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 9. Experience in Water Supply, Sewerage or Industrial Wastes Fields:

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10. Other Honors Received:

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11. Briefly outline outstanding achievements of the Nominee in his/her field:

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12. Indicate Nominee efforts and accomplishments in service to and leadership in the Conference:

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