Nominate 2021 | Career Mastered

Section I: Nominee Information

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Statement*

Please include a statement (no more than 250 words) describing why you (if you are nominating yourself) or your nominee (if you are nominating someone else) should receive the Women's Leadership in Action Award. Please note that as this is a writeable form, typed signatures will be accepted. By typing your name in the signature line you agree to the terms of release as stated below.

Check below if you consent*

Yes

I consent to the accuracy of the information contained in this nomination form. I understand that my application and supporting information become the property of Linwick & Associates upon submission, which shall have sole discretion in using these materials for the purpose of publicizing the Women's History Month Leadership in Action Awards program.

Nominee Name*

First Last

Date*

Section II: Nominator Information

Name

First Last

(if different from nominee)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Email

Phone

This field is for validation purposes and should be left unchanged.

Section I: Nominee Information

Section II: Nominator Information

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