Nominations for the Tom Utley Member Achievement Award can be made by any InSight Individual member in good standing by submitting the following form to the InSight Awards Committee.  Assistance in completing the background information can be obtained from the InSight Membership department.  Consideration should be given to the nominee’s involvement with InSight’s Committees, Councils, and SIGs, implementation of an innovative idea or project, presentations at InSight conferences, member recruitment/retention efforts, previous Board service or other noteworthy accomplishments on behalf of InSight and the user community. Deadline for nominations is July 1.

Please provide the following contact information:

Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
FAX
E-mail
I nominate the following InSight member for consideration for the Tom Utley Member Achievement Award:
Name
Title
Facility
Number of Years as Member
Description of reasons member should be considered for award: (Only complete sections that apply.)
Committee Positions	Board of Director SIG Chair SIG Vice Chair SIG Secretary
InSight Presentations
Member Services
Innovative Projects
Recruitment/Retention Efforts
Describe overall contributions to InSight and reasons for nomination