30 Leaders in their Thirties Nomination Form

NCI Salutes 30 Leaders in their Thirties recognizes North County leaders who are making a significant positive impact on our community through their profession and/or community involvement.   Consider nominating an up-and-coming professional at your company, a successful entrepreneur, a volunteer whose outstanding leadership skills are being used for the betterment of a charity, municipality or other organization. A young professional who is proactively helping create a more livable community. Those chosen will be recognized at our NCI Salutes 30 Leaders in their Thirties Reception on Tuesday, Oct. 31, 2017 at 11:30 a.m. – 2:00 p.m. at Christian Hospital, Detrick Building.   To nominate a deserving candidate, complete and return the following information (nominee must be in their thirties):   Deadline for submission is September 1, 2017.  
NOMINATION FORM
PLEASE FILL OUT THE FOLLOWING INFORMATION ABOUT YOURSELF:
NAME*:

EMAIL*:

PHONE:

ADDRESS:

PLEASE FILL OUT THE FOLLOWING INFORMATION ABOUT THE PERSON YOU ARE NOMINATING:
NAME:
EMPLOYED BY:

AGE:
EMAIL:

PHONE:

ADDRESS:

DESCRIPTION OF NOMINEE'S CONTRIBUTION
Please send bio and any necessary attachments to nci@northcountyinc.com
: