Bronze Koi Nomination

Presented By
Pacific Northwest Koi Clubs Association

1.	All information given must remain private.
2.	The person recommended must be active in a Koi club (10 years) within the regions of the Pacific Northwest, and must have been in the hobby of koi raising for at least 10 years.
3.	Candidates must be a hobbyist and not involved in the selling of Koi, Goldfish, or related products.
4.	Recommendations must be submitted to the current Bronze Koi Committee Chairman listed below by March 31st.  Mark the envelope “Confidential”.

Bronze Koi Committee

Committee Chairman:
Larry Christensen (NW Club)	
16952 NW Bernietta Ct.
Portland, OR 97229-7947 
(503) 531-3303
Lrcconst@hevanet.com	Committee Co-Chair:
Lindsay Gibson

I am recommending: ______________________________________________ (name) for nomination
to the Bronze Koi Committee. This person has shown distinguished service to the hobby of Koi
keeping. I understand that the committee makes the final decision for the award. I also understand that discretion should be used in obtaining background information on the nominee.
(Please be as detailed as possible when submitting information. Use several sheets of paper if necessary)

Street Address:_____________________________________________________________________
City: __________________________ Zip:_____________ Telephone: (     )____________________
Approximate Yrs of Koi Keeping:_____________________________________________________
Club Affiliations/Offices Held:________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Koi Activities and Contributions:______________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

Respectfully Submitted by:
Name:______________________________ Address:_______________________________________
City:_____________________________ Zip Code:___________ Telephone (     )________________