Nominated by
Name required
Phonetical Spelling of Nominator's Name required
Home address required
City required
State required
AK - Alaska
AL - Alabama
AR - Arkansas
AZ - Arizona
CA - California
CO - Colorado
CT - Conneticut
DC - Washington, D.C.
DE - Delaware
FL - Florida
GA - Georgia
HI - Hawaii
IA - Iowa
ID - Idaho
IL - Illinois
IN - Indiana
KS - Kansas
KY - Kentucky
LA - Louisiana
MA - Massachusetts
MD - Maryland
ME - Maine
MI - Michigan
MN - Minnesota
MO - Missouri
MS - Mississippi
MT - Montana
NC - North Carolina
ND - North Dakota
NE - Nebraska
NH - New Hampshire
NJ - New Jersey
NM - New Mexico
NV - Nevada
NY - New York
OH - Ohio
OK - Oklahoma
OR - Oregon
PA - Pennsylvania
RI - Rhode Island
SC - South Carolina
SD - South Dakota
TN - Tennessee
TX - Texas
UT - Utah
VT - Vermont
VA - Virginia
WA - Washington
WI - Wisconsin
WV - West Virginia
WY - Wyoming
AS - American Samoa
GU - Guam
MP - Northern Mariana Islands
PR - Puerto Rico
VI - Virgin Islands
FM - Federated States of Micronesia
MH - Marshall Islands
PW - Palau
AA - America
AE - Europe
AP - Pacific
Zip required
Company/Organization required
Preferred Email required
Preferred Phone Number required
Nominee's Volunteer Position(s): required
Length of Service required
In 100 words, please tell us how your nominee has impacted your organization. This summary will be printed in our event program. required
Do not exceed 100 words.