Chairpersons' Award Nomination Form

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SMSA Business Office
7881 S. Wellington Street
Centennial, Colorado 80122-3193

2010 CHAIRPERSONS' AWARD NOMINATION FORM
FOR OUTSTANDING CONTRIBUTIONS TO MOTORCYCLE SAFETY
sponsored by:

 

The SMSA Chairpersons' Award is sponsored by the National Association of State Motorcycle Safety Administrators. Each year the SMSA recognizes one of its members whose contributions to motorcycle safety has exceeded and gone beyond that which is generally accepted as being part of his/her responsibility. The award is intended to recognize the individual's commitment and contributions to motorcycle safety at local, state, and national levels.

Nominations are voted upon by a committee composed of the current and former Chairpersons of the SMSA. If a committee member is nominated for the award, he/she may either abstain from the selection process or be replaced by another member of the SMSA. The committee is chaired by the previous Chairperson.

DEADLINE

Nomination forms must be received by April 30, 2010
The award will be announced at the SMSA National Conference in August 

Name of Nominee:______________________________________________________________

Address:______________________________________________________________________

City:__________________________________State:_________________Zip:_______________

Nominee's Telephone No:________________________________________________________

Organization Nominee Represents:________________________________________________

Position Held:__________________________________________________________________

Number of years Nominee has been involved in motorcycle safety:______________________

NOMINATOR

Name:______________________________Signature:__________________________________

Address:_______________________________________________________________________

City_________________________________State:___________________Zip:_______________

Organization Nominator Represents:________________________________________________

Position Held:___________________________________________________________________

Nominator's Telephone No.:_______________________________________________________

CRITERIA FOR SELECTION

• Member of the SMSA (or contributor to the SMSA)

• Contributions to local and state motorcycle safety

• Contributions to national motorcycle safety

• Proven record of dependability and effectiveness in his/her position
  

Please summarize the contributions of the Nominee
Tell us what makes this individual worthy of the SMSA Chairpersons' Award.