ARRL

HPM Nomination Form

Please use this form to nominate an individual for the Hiram Percy Maxim Award.

Name *

(Person you are nominating)

Call Sign *

Address *

City *

State *

ZIP *

Day Phone *

E-mail *

Comments *

Please provide a short summary of this nominee's accomplishments

Your Name *

Your Call Sign *

Your Address *

Your City *

Your State *

Your ZIP *

Your Day Phone *

Your E-mail *