NATIONAL ASSOCIATION OF REALTORS

2014 DISTINGUISHED SERVICE AWARD NOMINATION FORM

A high quali ! "l"# $%&i# 'h% %g$a'h %( h" #a&)i)a " i* MANDATOR+ . All information must be completed in this format and resumes may be included along with to the completed nomination form. Only nominations submitted in this format will be considered. Th" Ca&)ia " MUST *ig& %(( %& hi* (%$, i&)i#a i&g ha h"-*h" ha* $".i"/") a&) a''$%." h" (i&al *u0,i**i%&1 Please provide a copy of the final application to the Candidate for his/her records. Applicant Name: Applicant Full ate of !irth: "ow long has the applicant been an active member# Applicant Office Address: Applicant "ome Address: $%mail: Cell Phone 2R"qui$")3: Office &elephone: 'hat !oard does the Applicant hold membership in# Nominated !y (name ) title*: +tate / ,ocal !oard Name: +tate / ,ocal !oard Address: &elephone: ate +ubmitted: "ome Phone:

-s the applicant still an active. participating member of their local board ) state association# ( 4l"a*" #i$#l"3 LOCAL 5OARD-ASSOCIATION: /es No &he applicant holds a valid real estate license in the +tate of (If the candidate does not hold such a license, he/she is not eligible for this award.) STATE ASSOCIATION6 /es No

RE7UIRED SIGNATURES As the Applicant for the 2014 NA !istinguished "er#ice Award, b$ signing below I hereb$ certif$ that I ha#e thoroughl$ read and appro#e these docu%ents for final sub%ission&
2014 DSA A''li#a& L%#al 5%a$) - A**%#ia i%& 4$"*i)"& or AE
Please mail or scan e%mail all completed documents to: Ali*a Th%,'*%&8 #-% E9"#u i." O((i#"* NATIONAL ASSOCIATION OF REALTORS 4:0 N%$ h Mi#higa& A."&u" ; Chi#ag%8 Illi&%i* <0<11=40>? NARDSA@$"al %$*1%$g ; 4h%&"6 :12=:2A=>41B

S a " A**%#ia i%& 4$"*i)"& or AE

('ost%ar(ed no later than )uesda$, April 1*th, 2014)