25 Women Honoree Profile Questionnaire

25 Influential Black Women in Business Awards

Honoree Questionnaire
Please complete this form that will capture information to be used to complete your magazine and video profile.
Full Name*

PrefixFirst NameMiddle NameLast NameSuffix
Title*
Company*
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Work Phone Number*

Area CodePhone Number
Cell Phone Number*

Area CodePhone Number
E-mail*
Assistant's Name

First NameLast Name
Assistant"s Phone Number

Area CodePhone Number
Assistant's E-mail
example@example.com
List all schools that you have attended for post-secondary education and degrees/certificates obtained*
Please attach a current resume AND biography highlighting your career achievements.

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Attach Resume Cancelof
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Briefly state three experiences and/or persons to whom you attribute your professional achievement and level of success and why:*
Briefly state the three most important things that you would like people to know about you. For example, education, community service, honors, personal triumphs, goals achieved:*
Give your favorite motivational quotation (literary, religious, folk saying, self-developed, etc.). Please cite its origin if known:*
Briefly state the one thing you would most like to do if you had thetime and money:*
Upload a Copy of your Business Card

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INVITATION LIST

Please list contract information for family, colleagues, and friends. We will forward email invitations to them to purchase tickets to attend the awards program. You may also forward your own prepared list. Note: Invitations are sent out by email ONLY. No hard invitations will be mailed.
UPLOAD MY OWN CONTACT LIST

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My contact list is provided below:
Name

First NameLast Name
Email
example@example.com
Name

First NameLast Name
Email
example@example.com
Name

First NameLast Name
Email
example@example.com
Name

First NameLast Name
Email
example@example.com
Name

First NameLast Name
Email
example@example.com
Name

First NameLast Name
Email
example@example.com
CONGRATULATORY ADVERTISING CONTACTS

Please provide contact information on individuals or companies whom we may contact regarding placing a congratulatory ad in your honor. You may also provide your own prepared list.
UPLOAD MY OWN CONTACT LIST

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My contact list is provided below:
Name

First NameLast Name
Company
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email
example@example.com
Name

First NameLast Name
Company
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email
example@example.com
Name

First NameLast Name
Company
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email
example@example.com
PHOTO HEADSHOT

One professional photograph to be used in your magazine profile. Photo should be at least 1MB in size.
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Photo Headshot Cancelof
PROFILE PHOTOS

Attach six (6) activity photographs of yourself to be used in the video presentation. The photos should be at least 1MB in size and show you in a variety of scenarios in your life, i.e. childhood, hobbies, career, family, academics, sports, travel, holiday celebrations, with VIPs, etc.
Photo #1

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Photo #2

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Photo #3

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Photo #4

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Photo #5

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Photo#6

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Please submit this form by THURSDAY, DECEMBER 12, 2019.
For questions contact
Rosalind McLymont at 25womendocs@tnj.com or call (212) 962-3791
Should be Empty:

25 Influential Black Women in Business Awards

INVITATION LIST

CONGRATULATORY ADVERTISING CONTACTS

PHOTO HEADSHOT

PROFILE PHOTOS