I wish to file an application for an SGA Humanitarian Achievement Award by certifying the following record:

Name of SGA member recommending the award:


Company name of SGA member recommending the award:

Title:   Date (mm/dd/yy):

Phone number      
Email address (required)

Name and residence address of nominee:

Job title, company name and address of nominee:

Place service rendered:

Date service rendered:

Time service rendered:

Company training used:

Character of service rendered. Give full and accurate details with statements or other evidence in support of this application.

Mail or fax reports, witness statements, and other supporting documents to:

Southern Gas Association
3030 LBJ Freeway
Suite 1300, LB 60
Dallas, TX 75234
FAX: 972-620-1613