ASP: Klumpke-Roberts Award Nomination Form

Klumpke-Roberts Award Nomination Form

Fill out form online by typing into the text boxes. Print the form from your browser and return by 15 December of nominating year to: Klumpke-Roberts Award Astronomical Society of the Pacific 390 Ashton Avenue San Francisco, CA 94112

Name of nominee:
Address:
Address 2:
City:
State/Province:		Zip/Postal Code:
Country:
Phone:		Fax:
Email:

Reason for nomination (75 words or less):

Attach nominating letter giving a brief description of nominee's positions, affiliations, accomplishments, publications, etc. (for publications, please list name of author(s), volume/number, pages(s) and dates).

Letters of Support from others familiar with the nominee's accomplishments are an essential part of the nomination materials. Please indicate the names and e-mail addresses of at least three persons you have requested to provide support letters. The letters should be forwarded by you or sent directly to the ASP.
Name of Supporter 1:
Email:

Name of Supporter 2:
Email:

Name of Supporter 3:
Email:

Name of person making nomination:
Address:
Address 2:
City:
State/Province:		Zip/Postal Code:
Country:
Phone:		Fax:
Email:

Signature of nominator:	__________________________________________________
Date: