The question is whether the elims can say 'We want CadCom to have a medallion', in which case he would receive a random medallion, or 'We want CadCom to have a nicrosil medallion', which would guarantee that Cadcom got a nicrosil medallion. I'm fairly sure that pewter medallions work as Eternum describes, as opposed to a permanent extra life and the immediate destruction of all pewter medallions.