ChemLuminary Awards Celebration

B. Main Contact Name: 
     Main Daytime Phone: Email address:

C. Our local section/division has been nominated for the following ChemLuminary award(s):

          Award  (Enter the name(s) of the awards in the fields below).

For more than four nominations, please complete and submit another form.  Award names can be found in the letter e-mailed to you earlier.

D. Indicate the name of the representative who will be at the Washington, D.C. national meeting to accept the award, should your Local Section or Division be named a recipient.

The contact above will be the designated representative for all awards. (Go to Section E).
The contact named above will be the designated representative for all awards except for:

Award #1:
Representative Name:
Daytime phone:
Email address:

Award #2 (if applicable):
Representative Name:
Daytime phone:
Email address:

Award #3 (if applicable):
Representative Name:
Daytime phone:
Email address:

Award #4 (if applicable):
Representative Name:
Daytime phone:
Email address:

E. Do any of the designated representatives require special assistance?
    Yes No

Indicate who and describe the type of special assistance needed.
(name, contact info, type of assistance required):

AUDIO-VISUAL

F. We will need digital photo(s) for the audio-visual portion of the ceremony for each nominated award by Wednesday, July 15th.

     Digital photo(s) have been emailed to chemlum@acs.org. Please indicate below next to the award the name of the file(s):

POSTER SESSION

G. Our local section/division will participate in the poster session from 8:00-8:45 pm. Setup at 6:00 pm.    Yes No

* Please note that each local section/division will have one poster to represent their accomplishments for the year. Poster Boards are 4' x 6'.

If your local section/division plans to participate in the poster session, please indicate the representative.

Main contact
Representative listed below:

Representative Name:
Daytime phone:       
E-mail address:       

H. Awards will be shipped to the Local Section chair immediately following the Awards ceremony. If there is a designee you wish to receive this award by FedEx other than the chair, please indicate below:

Representative Name:     
E-mail address:       

—> Please print a copy for your records.
—> Please complete this form by Monday, July 1, 2009.