Nominator First Name

Nominator Last Name

Nominator Email

Nominator Company

Nominator Title

Nominator Phone

Affiliation with Nominee

Nominee Name

Nominee Title

Nominee Company

Nominee Phone Number

Nominee Email

About the Nominee Describe why the nominee should be recognized and the impact he/she has made in the field/delivery of employee benefits in 500 words or less.

Achieved Outcomes Examples include improved health outcomes, realized savings, innovative ideas. Please be specific about the level of cost savings, process improvement, etc. Outline the achieved outcomes in 500 words or less.

Industry & Civic Contributions Please provide details on any contributions the nominee has made to advance the profession of employee benefits and/or the betterment of the overall workplace and/or community.

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