Nominations Application

2019 INFLUENTIAL WOMEN OF NORTHWEST INDIANA NOMINATION APPLICATION

Nominate the region’s most successful women professionals for influence in their businesses, industries and communities. Self-nominations are accepted. Nominees will be contacted for further information to determine award and business category. All nomination applications are reviewed by a selection committee consisting of a diverse group of leaders from the community.

2019 Nomination Application

Nominee
Name*
Company/Organization*
Title/Position*
Business Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Business Email*
Business Phone*
Nominator
Name*
Company / Organization*
Business Phone*
Business Email*