N.A.W.E.O.A. AWARD APPLICATION

In order to make things easier, the executive board would like to see the following form used to identify persons who you think should receive N.A.W.E.O.A. awards.

Name of Person to Receive Award: 

____________________________________________________________________________
(Surname)                    (First name)


Address:  
________________________________________________________________________________
(Street)               (City)                 (Country)  (Code) 

Jurisdiction: _____________________________________________________________
Title: _____________________________________________________________________


Name of Person Submitting Award Application: 

____________________________________________________________________________
(Surname)                    (First name)


Address:  
________________________________________________________________________________
(Street)               (City)                 (Country)  (Code) 

Jurisdiction: _____________________________________________________________

Title: _____________________________________________________________________
e-mail: _____________________________________________________________________

Date Submitted:   ___________________

Award Category (Check):

Award of Appreciation _____
Award of Valor         _____
Certificate of Award    _____ 
Certificate of Retirement  _____
Lifesaving  _____
Torch Award _____

Criteria:                         
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Please use additional sheets if necessary)

I need this certificate by (date): 
___________________________________

Award to be presented at N.A.W.E.O.A.  
Annual Conference  Yes_____    No____


Please mail to the Secretary/Treasurer allowing
plenty of time to process.  Make additional 
copies as needed.