Please complete this form to nominate a NCRTA member.  In the past, resumes alone have not been helpful in the decision process and are not required.  (Use back of page if needed).

1. Award Category: (circle one)       Distinguished Member   Outstanding Professional
                                                        Student of the Year        Certificate Of Recognition

2.  Name of Nominee:______________________________________________________

3.  Title:_________________________________________________________________

4.  Agency:______________________________________________________________

5.  Address: ______________________________________________________________
      _____________________________________________________________________
      _____________________________________________________________________

6.  Education:  ____________________________________________________________
     _____________________________________________________________________
     _____________________________________________________________________

7.  Joined NCRTA in (month/year): __________________________________________

8.  NCRTA Activity/Participation:
 
 
 
 

9.  Please state how this person meets the specific award criteria.  State specific examples
     related to the criteria.
 
 
 
 

10. Please give name, title, agency, address, and phone number of the person submitting
      this nomination:
 
 

Return by September 1, 2003 to:      Leslie Murray, TRS/CTRS
                                                            TR Services - Murdoch Center
                                                            PO Box 3000
                                                            Butner, NC  27509
                                                            Email: leslie.murray@ncmail.net
                                                            Fax:  (919) 575-1007