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IMCC Mine Safety and Health Training Awards - <br />Industry Award Category Nomination Form <br />(MUST be Completed and Submitted with the Nomination) <br />Attach additional pages, if needed <br />Important Dates: <br />• January 15: deadline for company nominations to be submitted to the state RA. <br />• February 1: deadline for State RAs to submit the selected states' nominations to IMCC (1 <br />nomination allowed per state per category per year). <br />Company being nominated (Company name as it should appear on the award, should the <br />nominee be chosen as the winner): <br />2. Nominating state RA contact person/phone/e-mail (The person we should contact with <br />any questions regarding the nomination): <br />3. Company contact person/mailing address/phone/e-mail (This should be the company <br />representative that we will contact and send the notification/Annual Awards Banquet <br />invitation to, should the company win the award.): <br />4. Category of the nomination (check applicable category): <br />❑ Coal Category -- Surface <br />❑ Coal Category -- Underground <br />❑ Metal/Nonmetal Category -- Surface <br />❑ Metal/Nonmetal Category -- Underground <br />Type of material or training program being nominated (video, safety talk, PowerPoint, <br />printed material, class, etc.): <br />