Joint Awards Nomination Form – MTC Conference & Exposition This Awards Nomination will be reviewed by the MTC Awards Committee each year for consideration. Please provide your nomination on or before November 15th. Nomination Submitted byPlease fill out your contact informationSalutation*Mr.Mrs.Ms.Dr.First Name* Middle Initial Last Name* Suffix (i.e.: Ph.D., P.E., Jr.) Job Title* Organization* Mailing Address* City* State/Province*Not Applicable, InternationalAKAZARCACOCTDCDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYZIP/Postal Code Country* Country*USAAfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweTelephone* CellEmail Address* Website Robert O. Vernon Membrane Plant Operator of the Year AwardThis award recognizes outstanding contribution to water supply improvement by an individual working at a membrane filtration, desalination and/or water reuse facility. Review Criteria includes: Outstanding contribution by a membrane plant operator which has resulted in significant, long-term improvement in water production and/or water reuse. Recipient may be an AMTA or AWWA member or nonmember. Award nominations may be submitted by AMTA & AWWA members, AMTA Affiliates and AWWA Membrane Committees. Please provide information below on the individual being recommended and a brief background. You may submit additional backup material if desired.Robert O. Vernon Operator of the Year Nominee Please list the individual you would like to nominate.Robert O. Vernon Operator Nominee Background InformationPlease provide a brief description of the indivdual you would like to nominate. Or upload your file and indicate that you have uploaded from this form.Must meet the following criteria: Continuously worked for at least one year as a licensed plant operator in a facility that contains at least one membrane based treatment process Exhibit a job effort that is above and beyond the normal requirement for his/her position Demonstrate a working knowledge of membrane processes and a willingness to further their knowledge on a regular basis Demonstrate the ability to positively represent his or her employer in the water or wastewater industry Letter of recommendation from supervisor or other management personnel Drop files here or Select files Max. file size: 100 MB. Must be actively supporting and volunteering in one or more of the following industry organizations (select all that apply) AWWA AMTA NWMOA SCMA SEDA SWMOA IDA Upload File for Robert O. Vernon Operator Nominee Drop files here or Select files Accepted file types: doc, docx, xlsx, xls, pdf, jpg, png, Max. file size: 100 MB. Please submit files in the following format only: doc, docx, xlsx, xls, pdf, jpg, pngOr email to admin@amtaorg.com Membrane Facility of the Year AwardThis award recognizes an outstanding water/wastewater facility which uses any membrane technology with high efficiency in an environmentally friendly approach. Review Criteria includes: Facilities where AMTA/AWWA site tours are conducted or would be given priority. AMTA/AWWA members would be given preference. Facility may be an AMTA or AWWA member or nonmember. Award nominations may be submitted by AMTA & AWWA members, AMTA Affiliates and AWWA Membrane Committees. Please provide information below on the facility being recommended and a brief background. You may submit additional backup material if desired.Membrane Facility of the Year Nominee Please list the facility you would like to nominate.Membrane Facility Nominee Background InformationInclude type of membrane application – water, wastewater, reclaimed, etc.; end-user served – public or private; how long in operation.Please provide a brief description of the facility you would like to nominate. Or upload your file and indicate that you have uploaded from this form.Size of Facility (mgd) Number of Plant Operators Safety Record/HistoryHistory of permit and/or regulation violations as recorded by the local regulating bodyMust meet the following criteria: Facility should have minimal impact to surrounding neighbors and/or appearance of the facility Education provided by facility to the public on water supply, water quality, treatment, and/or reuse Upload File for Membrane Facility Nominee Drop files here or Select files Accepted file types: doc, docx, xlsx, xls, pdf, jpg, png, Max. file size: 100 MB. Please submit files in the following format only: doc, docx, xlsx, xls, pdf, jpg, pngOr email to admin@amtaorg.com HiddenWater Quality Person of the Year AwardThis award recognizes an outstanding contribution by an individual in government, academia, research, or other, to water supply improvement. Review Criteria include: Outstanding contribution to water supply improvement through individual effort in the support of membrane or desalination technologies and/or water reuse. AMTA/AWWA members would be given preference. Recipient may be an AMTA or AWWA member or nonmember. Award nominations may be submitted by AMTA & AWWA members, AMTA Affiliates and AWWA Membrane Committees. Please provide information below on the individual being nominated and a brief background. You may submit additional backup material if desired.HiddenWater Quality Person of the Year Nominee Please list the individual you would like to nominate.HiddenWater Quality Nominee Background InformationPlease provide a brief description of the individual you would like to nominate. Or upload your file and indicate that you have uploaded from this form. HiddenUpload File for Water Quality Nominee Drop files here or Select files Accepted file types: doc, docx, xlsx, xls, pdf, jpg, png, Max. file size: 100 MB. Please submit files in the following format only: doc, docx, xlsx, xls, pdf, jpg, pngOr email to admin@amtaorg.com Comments & CaptchaCAPTCHAPlease enter the letters displayed above to complete your application and then click Submit.CAPTCHA Please refer to AMTA’s Privacy Policy if you have any questions regarding your preferences.