NOMINATION FORM
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IMPORTANT DATES
01/15/10 - NOMINATION DEADLINE
01/15/10 - STUDENT TEAM REQUEST DEADLINE
03/26/10 - ENTRY DEADLINE
04/20/10 - AWARDS LUNCHEON
PIEDMONT BUSINESS ETHICS AWARD
Nomination Form
NOMINEE INFORMATION:
Company:
Street Address:
City, State:
Zip Code:
Company Contact:
Please be sure this person is in charge of completing the company’s application.
Telephone
Fax
Email
Category:
A: Under 50 employees
B: 50-150 employees
C: 151-500 employees
D: Over 500 employees
Brief Description of Business:
Note: Non-profit organizations and financial service companies are not eligible to
participate. A financial service company is one that derives 25% or more of its
revenues from providing financial services or from the sale of financial products
(e.g. CPA, brokerage and insurance firms, banks, etc.)
Also, the company must be located in Rotary District 7690 as shown
here
.
Brief Explanation for Nomination:
Your affiliation with the nominee:
employee
customer
vendor
shareholder
private citizen
Society Members: Chapter Affiliation:
Nominator Information:
Self Nominated
Name:
Title:
Street Address:
City, State:
Zip Code:
Telephone:
Fax:
Email:
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