The Stephenson Honorary Fellow Award Nomination Form Name of nominee (first and last name): Contact information of nominee: Postal address: Email address: Phone number (if known): Name of nominator (first and last name): Email address: Country: Signature_____________________________________________ (electronic signature is acceptable) Date __________________________________________________ All applications must be received by the IOA Secretary, Katherine Fray by February 1st 2016. Send to secretary@internationalorthoptics.org