Emmy® Retirement & In Memoriam - Form

NATIONAL ACADEMY OF TELEVISION ARTS & SCIENCES

UPPER MIDWEST CHAPTER

Retirement & In Memoriam

Recognition Form

We are attempting to recognize individuals with at least 20 years of work in the chapter who may have retired or passed away between Sept. 1, 2024 and August 31st, 2025.

Submitter's First Name

Submitter's Last Name

TV Station or Company

Phone

Full name of the person you want recognized

Attach a high quality photo of person to be recognized

Station / Company Name

Attach a high quality station or company logo

Person's job title or position at station or company

TV station or company for recognition

Attach a high quality station or company logo

Select a category

Retirement In Memoriam

Attach a biography document (optional)

For retirement recognition, list number of years at company or in industry.

For In Memoriam, list birth and death years (i.e. 1938-2017).

IMPORTANT — This info will be used for recognition in Gala printed program.
Please provide biography/history (limit 500 words)