OMTA Honorary Life Member Award Nomination Form - OMTA

Nominee's Name*

First Last

Nominee's District*

Name of District President Making Nomination*

First Last

District President's Email*

Nominating Member's Phone Number*

Please describe in the fields below your reason for nominating this member.

Examples of Commitment to Students*

Examples of Commitment to Our Organization (OMTA)*

Examples of Commitment to Colleagues*

Email

This field is for validation purposes and should be left unchanged.