Name:	__________________________________________________
Title:	__________________________________________________
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I'm interested in
check all that apply; for * items, please attach 1-2-page resume or brief biography
Serving on the Award Advisory Board* Award Streering Committee*
Reviewing/revising criteria for making Awards
Selecting judges*
Judging applications for an Award*
Applying for an Award Best practice Innovation Life-time achievement
Receiving information on best practices and/or innovations that received an Award of Excellence
Attending a workship on the Awards program
Sponsoring the Awards program
Distributing information about Awards programs (to colleagues, meeting participants, members, et al)
Linking our website to www.hii.org
Being kept informed of progress

Nominating colleagues who would welcome being informed about the Awards – attach their contact information!

Remarks/requests – if necessary, please attach additional sheets

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