Nomination Form

NATIONAL HISTORIC CHEMICAL LANDMARKS PROGRAM

Fill in all categories and submit to the American Chemical Society's Office of Communications. You can also download a PDF version of this form.

* Required Information

Local Section, Division, or Committee:

Sponsor
Date of Submission
to ACS Headquarters
Primary Preparer*
Address*

Telephone Number*
Fax*
Email*

NOTE: ALL INFORMATION MUST BE COMPLETE FOR CONSIDERATION BY THE NHCLP ADVISORY COMMITTEE.

a. Seminal achievement:

b. Significant historical date(s):

c. Historical significance of this work:

d. Location:

e. What sets this work apart from related achievements:

f. Supporting evidence:
(List links or describe documents, photos, etc. to be mailed under separate cover)

g. Present condition and availability to the public:

h. List of commitments for financial support:

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