MEA Award Nomination Form

Nominee

Name (In Full) *

Residence Address *

Residence Telephone Number *

Business Address *

Business Telephone Number *

Present Occupation and/or Title *

Post Secondary Education *

Nominator

The undersigned hereby nominates: *

I have read and understand the terms of reference and have read and verify all supporting documentation provided with this nomination.

Note: The nominator will be considered the sponsor and will be the contact with the Municipal Engineers Association Awards Committee.

Date *

Name: *

Occupation *

Address

Address 1 *

City *

Province *

Postal Code *

Country *

Telephone Residence *

Telephone business *

Name of Nominator *

Seconders

The undersigned, hereby seconds the nomination of: *

for consideration of the Municipal Engineers Association Award. This nominee is a member in good standing of the Professional Engineers of Ontario, and I testify to the professional engineer’s good character and high ethical standards. I have read and understand the terms of reference and have read and verify all supporting documentation provided with this nomination.

First Seconder

Name *

Occupation *

Address

Address 1 *

City *

Province *

Postal Code *

Country *

Telephone Residence *

Telephone Business *

Second Seconder

Name *

Occupation *

Address

Address 1 *

City *

Province *

Postal Code *

Country *

Tel.Residence *

Tel.Business *