Applegate Nomination Form

Nominee: Submitted By: 
* Name:  * Name:
(if appropriate)
(if appropriate)
Address: Address:
* City: * City:
* State/Province: * State/Province:
Postal Code: Postal Code:
Phone: * Phone:
* Email address:

1. In brief, how has your nominee advanced the sea lamprey control effort? Please limit to 50 words or less.

2. Please describe how the nominee has displayed exemplary dedication to the sea lamprey control program and describe the specific accomplishments that warrant consideration for this award. Please limit to 300 words or less.

3. Please describe how your nominee's contributions are significant to the sea lamprey control effort. Please limit to 150 words or less.

4. Please provide brief biographical information:

OR attach the nominees' CV (please limit to one-page)

5. Please enter the number displayed here: