Select the award you are nominating for.

Daniel C. Hughes, Jr. Memorial Award William D. Ashman Award Fellow of the Society John A. Wagnon Technical Achievement Award Corporate Recognition Award

Person Being Nominated:

Name:               
Company:         
Address Line 1:
Address Line 2:
City:                          State:         Zip:
Country:            
Phone:                   Ext.:       Fax:
E-Mail:             
Chapter:            
Nominated By:  
Member of IMAPS Since:

National & Local Offices Held & Committee Positions:

Offices, Committees:	Dates:

Major Contributions to IMAPS, Microelectronics, & Electronic Packaging:

Technical Publications:

Professional Honors & Awards:

Other Pertinent Information:

The Following Section Applies to the Corporate Recognition Award Only!

Symposia Exhibitor (years):

Number of IMAPS Members in Company:

Number of Papers Presented by Employees at IMAPS Meetings:

Society Offices Held by Employees (Local & National):

Employee Name:	Position Held:	Date: