Award of Distinction Nomination Form

The Nominee

Name of Nominee

First Name*

Last Name*

Phone Number

Company

Company Name*

Street Address

City

Postal / Zip Code

Address Line 2

State / Province / Region

Country

The Nominator

Name of Nominator

First Name*

Last Name*

Phone Number

Company

Company Name*

Street Address

City

Postal / Zip Code

Address Line 2

State / Province / Region

Country

References

Reference 1

Reference 2

First Name*

Last Name*

Phone Number

Company

Company Name*

Relationship to Nominee

Summary of Nominee Qualifications & Achievements

Please submit a summary of the nominee's qualifications and achievement in a separate document, not exceeding two pages. Outline why this individual is deserving of this award and summarize their achievements and the impact they have had, and continue to have, on the coal industry. Include examples of how their efforts have contributed to the industry. Review previous recipients for more information.

Attach Qualifications & Achievements Document

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Additional Reference Information

Additional reference information, such as letters of support, other industry recognition or awards, photographs or news articles to support your nomination will help strengthen your nomination. Please keep supplementary materials to five pages and under.

Attach a File (if required)

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Submissions can also be mailed or emailed to info@coal.ca, to be received on or before 4:00 PM on the day of the deadline.

CAC Award of Distinction