IPM Achievement Award - Nomination Form

You can nominate a candidate by filling out and submitting this form. You can make your nomination brief as we will get details from the nominated groups. If you have problems using this form contact Michelle Andreetta at (916) 324-4245 and email at Michelle.Andreetta@cdpr.ca.gov

The deadline for nominations for the 2023 awards is June 30, 2023.

Candidate Organization or Group:

1.	Contact Information   (Please complete all fields)
(a).	Contact person for the Organization:
	Name:
	Address:
	Telephone:
	FAX:
	E-mail:
(b).	Name of person making nomination. We may want to contact you for more information. Please provide telephone number and email.
	Name:
	Telephone:
	E-mail: