Maryland Workers' Compensation Educational Association's Alfred M. Porth Memorial Award Nomination Form

Please complete the form below. Alternatively, you may upload a file with the requested info below:

The Alfred M. Porth Memorial Award was established by the MWCEA in 2001 to honor select members of the workers' compensation community for outstanding commitment to the fair and honest administration of the Maryland workers' compensation system. The Award is named for Alfred M. Porth (1916 - 1992), with the law firm of Smith, Somerville & Case and one of the foremost practitioners of Maryland workers' compensation law.

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* 1. I would like to nominate the following person for the 2020 Porth Award:

Name & Title

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 2. Nominee's service to MWCEA (includes but not limited to board service, speaker at MWCEA meetings/lunches, engaged member, helped to enhance the overall MWCEA brand, etc.

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* 3. How the nominee has earned peer recognition and through their years of work has strengthened the overall association foundation professional community.

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* 4. List nominee’s leadership roles with MWCEA as well as other areas of related professional organization volunteer service.

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* 5. Please answer the question (in no more than one page in length): What distinguished this nominee as a potential Porth Award honoree?

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* 6. Nominated by:

Name/Title

Company

Email Address

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* 7. Date of nomination.

Date / Time

Date

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* 8. If you prefer to upload your response, be sure to provide information covering the nominee's activities. In addition to this application form, supporting information may be attached; however, the entry should be limited to three pages. Information demonstrating the following should be submitted:

1. Nominee's service to MWCEA (includes but not limited to board service, speaker at MWCEA meetings/lunches, engaged member, helped to enhance the overall MWCEA brand, etc.

2. How the nominee has earned peer recognition and through their years of work has strengthened the overall association foundation professional community.

3. List nominee’s leadership roles with MWCEA as well as other areas of related professional organization volunteer service.

4. Please answer the question (in no more than one page in length): What distinguished this nominee as a potential Porth Award honoree?

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