McCartney Award Nomination Form - National Space Club Florida Committee

Your Name*

First Last

Your Company*

Your Email*

Your Phone Number*

Who are you nominating?*

First Last

Nominee Title*

Nominee's Company*

Nominee's Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Nominee's Email*

Nominee's Phone Number*

Tell us about your nominee’s work history. We’re looking for strictly biographical information here about your nominee: company/entity, positions held, when and where, etc.*

Describe the nominee’s specific accomplishments and how they significantly contributed to the success of the defense of our nation in a space-related area.*

Finally, please tell us as simply as possible why you think your nominee is deserving of this award.*