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Application for the William F. Fulginiti Legacy Award
*
Indicates required field
Date of Submission
*
Link
to Award Information and Candidate Criteria.
Link
to Word format of the application.
Nominator Information
Name
*
First
Last
Title
*
Work Address
*
Line 1
Line 2
City
State
Zip Code
Country
Email
*
Work Phone Number
*
Award Candidate Information
Name of person you are nominating
*
First
Last
Current Title
*
Board Member
*
Dates Served on Board
*
Their Years of Service to the League or Pool
*
Email
*
Phone Number
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Reason for Nominating the Person (Please provide a detailed description here to demonstrate why this person should be a Fulginiti Legacy Award recipient. You are encouraged to include specific examples of his/her contributions.)
*
If including supplemental materials with your nomination please upload them here or email them to Jwade@nlcmutual.com
*
Max file size: 20MB
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