George West

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

GEORGE H. WEST MEMORIAL AWARD

NOMINATION FORM

The George H. West Memorial Award is awarded not more than annually to a man with at least fifteen (15) years of experience in the water/wastewater field and has demonstrated ability and leadership in Conference activities. Nominations for this award must be submitted to the awards committee with endorsements of at least three (3) current officers or board members.

The purpose of this award is to recognize outstanding performance by a conference member in supporting the ideals and goals of the conference and to encourage and inspire others to likewise serve the public good and the conference.

Date:

____________________

1. Nomination submitted by:

_________________________________________________________________________

2. Name of Nominee:

_________________________________________________________________________

3. Address:

_________________________________________________________________________

4. Present Employer:

_________________________________________________________________________

5. Title of Present Position:

_________________________________________________________________________

6. Certification Status: Louisiana Classification:

_________________________________________________________________________

Field:

_________________________________________________________________________

7. Education and Training:

_________________________________________________________________________

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

_________________________________________________________________________

9. Other Honors Received:

_________________________________________________________________________

10. Comments:

_________________________________________________________________________