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:
Society Members: Chapter Affiliation:
Nominator Information:
	Self Nominated
Name:
Title:
Street Address:
City, State:
Zip Code:
Telephone:
Fax:
Email: