1st Nomination

You can nominate up to 3 candidates on this form. If you want more information about the nomination process, CLICK this LINK.

Question Title

* 1. Your Name

Question Title

* 2. Email 

Question Title

* 3. Phone

Question Title

* 4. Are you an LPCA Member?

Question Title

* 5. Name of the person you are nominating.

Question Title

* 6. Do they know you are nominating them?

Question Title

* 7. Nomination / Award

Question Title

* 8. How do we contact the person you nominated for this Award?

Question Title

* 9. Which of the following best describes your current relationship to nominee?

Question Title

* 10. Anything else we should know?

Question Title

* 11. Would you like to nominate another candidate?