x2024 Request for Certificates & Awards

Please provide below the information on the award that your SIG or Chapter would like to present. Please remember that all recipients of ASIS&T awards must be ASIS&T members. You can confirm an awardee's membership status by searching for them in the membership directory.

If your award is more than $500 and your awardee pays US taxes, please include a W-9 Form.

Fields marked with an * are required.

Group Requesting Certificate/Award *

Name of person submitting form *

Email address of person submitting form *

Do you wish to present a certificate to the award recipient?

Note: we will only print certificates for individuals registered to attend the Annual Meeting by October 11, 2024.

First Name of awardee *

Last Name of awardee *

Award Recipient Email

Name of recognition *

For example: Watson Davis Award for Service

Name of Paper/Publication (if applicable)

Amount of cash award (if applicable)

Payment Request Form for Cash Awards

Please upload a completed Payment Request Form. Payments will not be processed without complete awardee information.

20MB max

Non-Cash Award (if applicable)

Please describe what the awardee should receive if not cash. For example: workshop or meeting registration, etc.

W-9 Form

If award is over US$500 and awardee pays US taxes, please upload a completed W-9 form.

20MB max

Please verify that you have checked the “I'm not a robot” checkbox.