Carlsbad 40 Under 40 Nomination Form
Please fill out this form completely. Your nominee is graded on both work accomplishments AND volunteer work. There is a $50 nonrefundable nomination fee due upon submission of this form.
Your Name
*
First Name
Last Name
Your Email
*
example@example.com
Your Phone Number
*
Please enter a valid phone number.
NOMINEE INFORMATION
Complete all fields for full consideration.
Nominee Name
*
First Name
Last Name
Nominee Email
*
example@example.com
Nominee Phone Number
*
Please enter a valid phone number.
Nominee Birth Date
*
-
Month
-
Day
Year
Date
Nominee Place of Work
*
In 250 words or less, tell us why this person should be considered for the Carlsbad 40 Under 40 Class of 2023
*
Work and volunteer accomplishments
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Nomination Fee Non-Refundable
Nomination Fee - Non-Refundable
$
50.00
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Item subtotal:
$
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Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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