Golden Manhole Society Award

SECTION 1
Nominator Information Please complete the following information for the person completing this nomination.
Nominator Full Name *
Nominator Organization *
Nominator Professional Title
Nominator Address (Include City, State, and Zip) *
Nominator Phone *
Nominator Email Address *
SECTION 2
Nominee Contact Information Complete the following fields related to the person being nominated for the award.
Nominee Full Name *
Nominee Employer *
Nominee Professional Title
Nominee Address (Include City, State, and Zip) *
Nominee Phone *
Nominee Email Address *
SECTION 3
Nominee Professional Information Complete the following fields related to the nominee's certifications and membership. When listing involvement with AWWA, WEF, and NC One Water, include activity with the national AWWA and national WEF in the AWWA Involvement and WEF Involvement fields. Participation within North Carolina should be listed in the NC NC One Water Involvement field. If you would prefer, you may answer questions in a Word document, convert the document to a PDF file, and upload the responses with your nomination.
Certifications Held (Include Type and Level)
Memberships (select all that apply)	AWWA WEF NC SLAM
AWWA Involvement
WEF Involvement
NC AWWA-WEA Involvement
SECTION 4
Nominee Accomplishments Use the questions below to give sufficient reasoning as to why the nominee should be considered for induction. If there is not enough space to adequately answer the questions, continue on a separate document and upload below. You may also upload any supporting documents you feel support the nomination.
List the significant contributions the nominee has made in fields of water and wastewater
Check this box if you wish to speak to a member of the Collection and Distribution System Committee	I wish to be contacted to discuss the achievements of the nominee
SECTION 5
Uploading Supporting Documents If you would like to upload responses to open-ended questions, or additional materials, please convert them to PDF format and merge all documents into a clearly labeled file.
Upload any supporting documents here