Regional Fellow's Medal Request

Regional Fellows Medal Request Form

This award acknowledges those Fellows who go above and beyond, whose contributions at the Post, Regional and/or National level truly stand out. Nominations for this award will be accepted from the Post or Regional Fellows Point of Contact or AOF XC Members. These exceptional individuals will be recognized during signature Post, Regional, and Fellows events or at annual national conferences, adding a new layer of distinction to our vibrant community.

Recipient Information

Recipient Name(Required)

Prefix First Last

Recipient’s Post Affiliation(Required)

Recipient’s RFPOC Name(Required)

Recipient’s RFPOC Email(Required)

Justification for Award (may be used in newsletter / announcements)

Nominator Information

Nominator Name

Prefix First Last Suffix

Nominator Email

Nominator Phone(Required)

Position

Date Award Needed (Typical turnaround is 14-21 days. See below for details.)(Required)

Shipping Information (medal should be shipped to presenter, not recipient)

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Additional Information or Instructions

Shipping and Handling (Check one. Cost of medal and S&H covered by HQSAME)

Express Shipping 3-5 Days (in addition to two week preparation time

Ground Shipping 7-10 Business Days

After an order is placed it takes approximately 7 days for processing, production and engraving, then your order will ship based on your choice of the two shipping options (Express Shipping or Ground Shipping).

To confirm receipt of your Regional Fellows Medal request, please contact Kathy Off via email: koff@same.org.

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Regional Fellow’s Medal Request