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Nomination Form for the 2012 Woman of the Year

The Women In Business Council of the Northern Palm Beach County Chamber of Commerce is proud to announce the 2012 Woman of the Year Award. Created to honor an Outstanding Leader, this award will be presented to a woman who has attained and personified the highest level of professional excellence in business and the community. The award will be presented at the Women In Business Luncheon on October 23 at the DoubleTree Palm Beach Gardens.

We encourage all Nominators to meet with your Nominee to get the most accurate information to fill out the Nomination Form.

All nominations will be anonymous this year. Please do not discuss your nomination with Women In Business Council Members or Members of the Chamber’s Board of Directors.

If you have any questions please contact Kay Hicks 561-776-1667 or Donna Goldfarb 786-200-3151.

Deadline for nominations is September 28, 2012.


Nominee:

Name:


Title or Position:


Name of Company:


Address:


Phone:


E-mail Address:


Website:


Nominator:

Name:


Name of Company:


Phone:


E-mail Address:


BUSINESS ACCOMPLISHMENTS:
List special recognitions, projects and achievements:


COMMUNITY SERVICE:
Describe local, county and state level participation and offices held in civic and service organizations, charitable activities, and political pursuits. List any leadership roles held in the community this past year.


OTHER ACHIEVEMENTS, AWARDS, PUBLICATIONS:
Professional, industry or community activities:


PROFESSIONAL ASSOCIATIONS:
List industry or professional associations and nominees involvement in each:


CHAMBER INVOLVEMENT AND ACTIVITIES:
List activities of involvement and length of service for each:


PERSONAL ACCOMPLISHMENTS AND ADDITIONAL FACTORS:
Provide any additional information that makes the nominee deserving of this award:




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800 North US Highway One • Jupiter, FL 33477 • Phone: (561) 746-7111 • Fax: (561) 745-7519
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