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Honoree information
Please select:  
Honoree Last Name:
Honoree First Name:
Middle Initial:
Work Affiliation:
(current or from which retired/emeritus status was granted

 
City and State of Work Affiliation:
Honoree Address Line 1:
Honoree Address Line 2:
Honoree City:
Honoree State:
Honoree Zip:
Honoree E-mail:
Tribute for Honoree:
Please explain your reasons for wishing to honor this person in 250 words or fewer.
 
Do you have an appropriate photo of the honoree alone or with you?  
If yes, please send a digital copy of the photograph to khughes@nysaflt.org. Please make sure the e-mail clearly states who you are and who is being honored. You will receive a confirmation of your submission.

Please note that there are no anonymous submissions.
You will be listed as the author of the tribute on the People Who Inspire web page.
 
 
Your information  
Last Name:
First Name:
School/Work Affiliation:
School/Work City:
School/Work State:
School/Work Zip:
Home Mailing Address:
Home City:
Home State:
Home Zip:
Phone:
Email:
 
Payment Information  
 
The suggested minimum donation to honor a colleague is $25. All donations received will help support our many student and teacher scholarships, grants and awards.
Larger donations are graciously accepted!
Payment by Credit Card
See below.
Payment by PayPal 

Donation Amount: $
The suggested minimum donation to honor a colleague is $25. All donations received will help support our many student and teacher scholarships, grants and awards.
Larger donations are graciously accepted!

We encourage you to print out this confirmation page for your records. This will appear immediately after you press the "SUBMIT" button below.

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