Saturday, May 18, 2013

Clone of NOMINATION FORM

2012 Twenty Five
Influential Black Women
in Business Awards

25 Influential Black Women

NOMINEE INFORMATION

Name:

Nominee Full Name

Title:

Company:

Address:

City:

State:

Zip:

Phone:

Fax:

Email:

Industry:

Years in business or length of employment:

REASONS FOR NOMINATING

500 words or less Briefly state why the individual deserves the award here:

NOMINATOR'S INFORMATION

Name: *

Nominator's Full Name

Title:

Company:

Address:

City:

State:

Phone:

Fax:

Email: *

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