Present position: 

Lenth of time in this position: 

Business address (including street, city, state, zip): 

Phone number:      
Fax number:               

DSN phone:           
DSN fax:                 

Work email: 

Accomplishments. (No more than 250 words please.)
Include the following information in your statement:

     1) Describe in detail the contribution(s), how and when they were provided, and the role of the nominee.
     2) Describe the specific benefits of the contribution to the Military Librarians Division.

NOMINATOR'S INFORMATION

Name: 

Business address (including street, city, state, zip): 

Phone number:      
Fax number:               

DSN phone:           
DSN fax:                 

Work email: 

SLA membership number: