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Name, City, State and Nation of Organization Being Nominated / Nominee's Organization*: (example: XYZ Company, Milwaukee, Wisconsin, U.S.A.)

Your Organization’s Name (If Different):
Industry of Organization Being Nominated/
Nominee's Organization* :
Number of Employees at Organization Being
Nominated / Nominee's Organization* :
Two-sentence Description of Organization Being Nominated/Nominee's Organization*(maximum 400 characters) : (example: XYZ Company is Milwaukee’s most innovative design consultancy. Founded in 1997 by our president, Jane Doe, XYZ employs eight people and has won numerous awards for our design concepts and customer service. )
Your Organization’s Address * :
Your Organization’s City * :
Your Organization’s State/Province:
Your Organization’s Zip/Postal Code * :
Your Organization’s Country * :
Contact Person’s First Name * :
(Contact Person will receive all correspondence about the disposition of all entries submitted.)
Contact Person’s Last Name * :
Contact Person’s Phone Number * :
Phone Extension:
Contact Person’s Work Email * :
Contact Person’s Fax Number:
Entries Will Be Submitted in This Language:
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Confirm Password * :
Enter in CAPS the text you see in the image below * :
 
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