Group Requesting Certificate/Award *

Name of person submitting form *

Email address of person submitting form *

Do you wish to present a certificate to the award recipient?

Note: we will only print certificates for individuals registered to attend the Annual Meeting by October 11, 2024.

Yes No

First Name of awardee *

Last Name of awardee *

Award Recipient Email

Name of recognition *

For example: Watson Davis Award for Service

Name of Paper/Publication (if applicable)

Amount of direct financial award (if any)

Do not indicate reimbursements here, only direct "cash" awards

Payment Request Form for Direct Financial Awards

Please upload a completed Payment Request Form. Payments will not be processed without complete awardee information. Forms should be signed by a SIG or Chapter Officer.

20MB max

Non-financial awards (including reimbursement)

Please describe what the awardee should receive if not direct money. For example: workshop or meeting registration, travel reimbursement, etc.

W-8 or W-9 Form

For all financial awards (non-reimbursement), please upload a completed W-9 form (US Citizens) or W-8 BEN form (non-US Citizens).

20MB max

Membershp Confirmation *

I affirm that I have confirmed the membership status of this individual and the are a current member of ASIS&T. 

Enter required value Yes No

Request Declined

Your request to make this award cannot be approved until you have confirmed that the individual is a current member of ASIS&T. Please take this step then type "confirmed" below if their membership is confirmed. If the individual is not a member, please inform them that they must join the association before they can receive the award and wait to submit your request until this has been done.