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 November 3, 2025.

Enter required value 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 over $600 (non-reimbursement), please upload a completed W-9 form (US Citizens) or W-8 BEN form (non-US Citizens).

20MB max

Membership Confirmation *

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

Enter required value Yes No