Tony Torchia VRWA Award Nomination Form

The Tony Torchia Vermont Rural Water Special Recognition Award honors a person affiliated with the water-wastewater industry for extraordinary effort or accomplishment during the previous year or over the course of a career. All members are invited to submit nominations.

For consideration for the 2008 award, this form must be received by the VRWA administrative office by January 31, 2008.

Nominee Contact Information

Name of Nominee:
Nominee's System/Affiliation:
Nominee's Position:
Nominee's Address:
City:
State:		Zip:
Phone:
Is the nominee affiliated with a member of VRWA?: Yes No Unsure

Nominee Qualifications:

Please enter a brief, one paragraph description of the nominee's recent contribution to the field. Please also describe any relationship that exists between the nominee and VRWA. Thank you for your nomination!

Your Information

Your Name:
Your Phone:
Your System/Affiliation:

Enter the two words displayed into the box below:

Items in bold are required.