WIM Recognizes Form | American Trucking Associations

1 Current: Basic Information
2 Questions
3 Complete

Are you nominating someone or applying yourself

Nominating

Applying

Date of Form Submission

First Name

Last Name

Email

Phone Number

Home Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Applicant employment status

Currently employed

Not employed

Title

Company

Company Website

Company Phone Number

Business Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

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