Award Nomination Payment Please use the form below to pay the fees for your 2021 Awards Nominations. Name* First Last Email*This needs to be the email address that was used to submit the award. Phone*Award Title*InnovationTeachingQuality ResearchInnovation, Teaching, Quality ResearchAward LevelGoldSilverBronzeGold, Silver, BronzeAddress to ship award plaque*Award Plaque Fee*Award Plaque$100.00 fee for 2022 USDLA International Distance Learning Awards plaque. Includes shipping to US-based address.Number of Awards*If you need to pay for more than one award, please indicate here.123456789Total $0.00 Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name Credit card processing by Stripe. No credit card information is stored on USDLA servers.