Society Of Economic Geologists Form
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2SOCIETY OF ECONOMIC GEOLOGISTS
AWA R D • N O M I N A T I O N • F O R M
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PLEASE
Penrose Medal
SEG Silver Medal
Marsden Award
Lindgren Award
CHECK ONE
P
I
(
)
ART
NOMINEE DETAILS
Personal Information:
(Type or Print)
Ms / Mr / Dr ___________________________________________________________ __________________________________________ ____________
Last Name
First Name
Middle Initial
Company / Institution _____________________________________________________________________________________________________________
Mailing Address _________________________________________________________________________________________________________________
City _______________________________________ State/Province ______________________ Postal Code ______________ Country __________________
Phone ________________________________ Fax__________________________________ Email_______________________________________________
Education:
(Type or Print)
YEAR
COMMENDATION
UNIVERSITY AND LOCATION
DEGREE
OBTAINED
(e.g., cum laude)
Highest Degree: ____________________________________________ __________________________ _______________ ________________________
Other Degree: Ph.D. _________________________________________ __________________________ _______________ ________________________
M.Sc. ________________________________________ __________________________ _______________ ________________________
B.Sc.(Hons) ___________________________________ __________________________ _______________ ________________________
B.Sc. _________________________________________ __________________________ _______________ ________________________
Other_________________________________________ __________________________ _______________ ________________________
Professional Experience:
(Only most important need be listed)
YEARS (M/YR)
POSITION
EMPLOYER
From ______ PRESENT
____________________________________________
___________________________________________________________
From ______ To _______ ____________________________________________
___________________________________________________________
From ______ To _______ ____________________________________________
___________________________________________________________
From ______ To _______ ____________________________________________
___________________________________________________________
List Medals and Other Awards:
YEAR
MEDAL/AWARD
INSTITUTION
__________________ ______________________________________________
___________________________________________________________
__________________ ______________________________________________
___________________________________________________________
__________________ ______________________________________________
___________________________________________________________
__________________ ______________________________________________
___________________________________________________________
Significant Accomplishments/Publications:
(for accomplishments, give specific examples; for publications, list no more than 5 titles)
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
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