Oregon Bio Women Nomination Form
Use this form to nominate someone to serve on the OBW Committee
Nominator Name
*
First Name
Last Name
Nominator Email
*
example@example.com
Nominator LinkedIn Profile Link
*
Nominee Name
*
First Name
Last Name
Nominee Email
*
example@example.com
Nominee Company
*
Nominee cellphone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Nominee LinkedIn profile link
*
Nominee business classification
*
Please Select
Biotech
Healthcare
Medtech
Med device
Pharma
Other
Nominee achievements, contributions, recognition or early-stage career
*
How has the nominee uplifted and elevated other women? Please be specific.
*
Does the nominee serve on any boards?
*
List up to 3 other Oregon women who you, the nominator, consider to be an inspiration in the biotech community
*
Upload a letter of recommendation for the nominee (optional)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Submit
Should be Empty: