Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.NominatorDetails of the person submiting the nomination.Your Name *FirstLastEmail *Company Name *Company Website / URL *Your job title *Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Nominee InformationDetails about the person being nominated.Nominated Person *FirstLastAddress *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail *Company nameCompany Website / URL (copy) (copy)Cell phone number *Nominee Bio - winners bios will be published (include background & accomplishments) Must be 450-550 Words *Why should this person win an award? Must be 200-250 words * Custom the Phone Describe the community involvement and philanthropic contributions of the nominee. 150-200 words *What boards, associations, non-profits has the nominee served on or currently serves on? Must be 150-200 words. *Upload company logo Click or drag a file to this area to upload. Nominee Profile Photo (Head Shot) High resolution required * Click or drag a file to this area to upload. As the nominator, please confirm you have obtained nominee’s consent* As the nominator, please confirm you have obtained nominee’s consent *Yes, I have obtained the Nominee's consent to be submittedStripe Credit Card *AddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip Code Please choose corresponding fee *Individual submission - $15.00Government submission - $20.00Organization submission - $20.00By submitting my payment I confirm that I have read, understood, and agree to abide by all the rules and guidelines of the contest, including eligibility requirements and submission deadlines. The Ambassadorial Roundtable is not responsible for submissions. Exemption from liability: The Ambassadorial Roundtable shall assume no liability for the accuracy or completeness of the published report and is merely providing space for the submission of and access to third-party content. Liability for the content of a report lies solely with the author of such report. Custom Captcha * = Submit