Please include a current photograph, if possible.

Award Category:
_____________________________________________________________________________

Please fill out the appropriate section:
Name/Address/Phone of person being nominated:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________

Title of Book or Publication (if appropriate)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

Name, location, and/or address of object being nominated:
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________

Why should this person/object receive this award?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Name/Address/Phone of person making the nomination:
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________

Email address:________________________________________________

Please include any other pertinent information on a separate sheet

Send to: DACHS Awards Committee
BOX 16045
Las Cruces, NM 88001