IOWA CHAPTER OF THE WILDLIFE SOCIETY

NOMINATION FORM FOR CONSIDERATION FOR:

 (choose one of the following)

______  IOWA CONSERVATION AWARD OF MERIT

______ IOWA CONSERVATION HALL OF FAME

Nominee:________________________________

City:____________________________________

State:___________________________________

Year: Birth _________ Death: _________.      Place of Birth: _______________________

Employer: ____________________________________________

Title of position: __________________________________________

Education (where):       

Elementary ___________________________________

Secondary ____________________________________

College __________________________Degree (s) ______________Year ______

College __________________________Degree (s) ______________Year ______

College __________________________Degree (s) ______________Year ______

College __________________________Degree (s) ______________Year ______

Spouse: _______________________

No. of children: _______

MAJOR CONTRIBUTIONS TO CONSERVATION

(attach separate sheet as necessary)

Nominated by _____________________________    Date __________________

Please justify nomination with details, then return the form to the current secretary of the Iowa Chapter of the Wildlife Society.

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SUPPLEMENTAL DATA:

Awards or Recognition Previously Received:

Offices and Committee Assignments held to Date:

Society or Association                      Office or Committee                    Location                Date

Most Recent Publications:

Comments: