40 Under Forty Nomination Form

Important Information

40 Under Forty recognizes 40 ambitious, hard-working, civic-minded individuals, who are under the age of 40, and who have excelled in the workplace and in the community.

Nomination deadline is October 7, 2011 by 5:00p.m.

This is the 14^th annual 40 Under 40 Awards Luncheon recognizing 40 people under the age of 40 who have excelled in the workplace and in the community. We invite you to participate in this event by nominating an outstanding member of the community you feel is deserving of this recognition. The event culminates in November with an awards ceremony and a luncheon to honor the winners.

Nominees must be 39 years old or younger as of October 31, 2011.

Please fill out this nomination form completely. Thank you.

40 Under Forty Nomination

Nominee Information

Nominee Name:

Title:

Company/Organization:

Address:

City:

State:

Zip:

Company Phone:

Nominee's Email:

Nominee's Age (as of Oct. 31, 2011):

Nominee's Birthday (MM / DD / YYYY):

How did you hear about the 40 Under Forty Awards? (You may choose more than one):

Advertisement in TBJ, Mohawk Valley Business Journal or Greater Binghamton Business Journal paper
Advertisement on the CNYBJ website
Email
BizEventz website
Other

Supporting Documentation and Material

College(s) attended and degree(s) earned, along with other certifications::

Business accomplishments (specific achievements, special projects, business-related affiliations):

Civic leadership (What impact has this person had on his/her community):

Achievements, awards, and special recognitions:

Family (spouse, children):

Comments:

Your Information

Nominated by:

Your Title:

Your Company:

Your Email:

Your Phone:

Your Address:

Your City:

Your State:

Your Zip:

Upload any supporting Documents (recommendations, resume, articles, etc.) :

Submit My Nomination