Form: NARCDC-AW #1

Application for Consideration

For Membership in the

RC&D Hall of Fame

Candidate’s Name:  ___________________            Submitted By:  ___________ Region:  _____________________________            Date:  __________________

Proposed By:  _________________________________ RC&D Council;

Address:  _______________________________________________________________

Telephone:  __________________                        E-Mail Address:  ____________________

Years Involved in RC&D Program:  ________

RC&D accomplishments and positions held:  

Explain why this person should be so honored, including his/her contributions towards strengthening and advancing RC&D nationwide through involvement of local RC&D councils (a limit of one additional page [both sides] will be allowed):

Signed By:  _______________________________                        Date:  __________________

Title:   ___________________________________