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NATIONAL INFANTRY ASSOCIATION 1775 Legacy Way Suite 210 Columbus GA 31903 Phone 706 323-2560 Fax 706 323-0967 THE ORDER OF SAINT MAURICE NOMINATION FORM Name of the Nominee including Rank/Grade Address of Nominee Nominees Army Branch or Service if Military City State Zip Code Member Y N Nominee s Phone Number Name of Nominator including Rank/Grade Date of Submission Nominator s Phone Fax Number Nominator s NIA Chapter/Mbr No. Enclosed is the appropriate payment for the Award Package Medallion Certificate Processing Handling Special Rush Handling 40. 00 10. 00 TOTAL Peregrinus Award Civis Award Legionnaire Award Centurion Award Primicerius Award 40. 00 5. 00 Express Delivery will cost more. Rush orders requiring special handling will cost an additional 10. 00. Please call ahead to get an exact amount on an Check payable to NIA enclosed or charge to Mastercard VISA AMEX Signature Credit Card Number Exp* Date 5. Anticipated date of induction ceremony Required for rush orders ATTACH NARRATIVE ON SEPARATE SHEET Allow 30 days after final board approval for processing of medal and certificate PLEASE READ CAREFULLY It is the responsibility of the nominator to ensure that nominations are complete to include payment and appropriate NIA membership status. Incomplete packets will not be processed nor will the NIA be responsible to notify the nominator. Due to increased volume awards should be submitted at least 5 business days prior to bimonthly Awards Board meetings normally around the 1st and the 15th of each month to ensure their submission for that meeting. Submissions which are submitted too late for that meeting may not be changed to rush status because doing so disrupts the schedules of Board members and staff* All awards submitted as rush must be accompanied by a written justification for late submission*. 00 10. 00 TOTAL Peregrinus Award Civis Award Legionnaire Award Centurion Award Primicerius Award 40. 00 5. 00 Express Delivery will cost more. Rush orders requiring special handling will cost an additional 10. 00 5. 00 Express Delivery will cost more. Rush orders requiring special handling will cost an additional 10. 00. Please call ahead to get an exact amount on an Check payable to NIA enclosed or charge to Mastercard VISA AMEX Signature Credit Card Number Exp* Date 5. 00. Please call ahead to get an exact amount on an Check payable to NIA enclosed or charge to Mastercard VISA AMEX Signature Credit Card Number Exp* Date 5. Anticipated date of induction ceremony Required for rush orders ATTACH NARRATIVE ON SEPARATE SHEET Allow 30 days after final board approval for processing of medal and certificate PLEASE READ CAREFULLY It is the responsibility of the nominator to ensure that nominations are complete to include payment and appropriate NIA membership status. Anticipated date of induction ceremony Required for rush orders ATTACH NARRATIVE ON SEPARATE SHEET Allow 30 days after final board approval for processing of medal and certificate PLEASE READ CAREFULLY It is the responsibility of the nominator to ensure that nominations are complete to include payment and appropriate NIA membership status. Incomplete packets will not be processed nor will the NIA be responsible to notify the nominator. Due to increased volume awards should be submitted at least 5 business days prior to bimonthly Awards Board meetings normally around the 1st and the 15th of each month to ensure their submission for that meeting.

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