Nominee's Name:
First Name
Last Name
Title:
Business Name:
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number:
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Submitted By:
First Name
Last Name
Submitted By Phone Number:
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1. Business Accomplishments: List special recognitions, accomplishments or projects within the nominee’s place of business, to include business-related affiliations, significant promotions, directorships, trusteeships, or other designations.
2. Community Service: Local, County, or State level participation(vs. simple membership) in civic and service organizations, charitable activities, political pursuits, religious groups, and/or other involvements such as merchants associations, youth groups, etc. Please list offices held, including dates.
3. Chamber of Commerce Activity: Work done on councils, committees, boards, to include special projects, membership drives, activities, accomplishments, etc., as well as involvement with any other chambers of commerce.
4. Women’s Division Activity: Work done on committees to include special projects.
5. Other Achievements, Awards,Accomplishments :
6. Essay About Nominee and Personal Information
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