women 2015 NOMINATIONS APPLICATION APPLICATIONS SUBMITTED TO: NATALIE HABER-BARKER NHABERBA@NWIWOMEN.COM DEADLINE: JUNE 19, 2015 2015 INFLUENTIAL WOMEN OF NORTHWEST INDIANA NOMINATION APPLICATION 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. NOMINEE Name: _______________________________________________________________________________________________ Company / Organization: ________________________________________________________________________________ Title / Position: ________________________________________________________________________________________ Business Address: _____________________________________________________________________________________ City / State / Zip: _______________________________________________________________________________________ Business Email: _______________________________________________________________________________________ Business Phone: _______________________________________________________________________________________ NOMINATOR Name: _______________________________________________________________________________________________ Company / Organization: ________________________________________________________________________________ Business Phone: ________________________________________________________________________________ Business Email: ________________________________________________________________________________ 2015 EMPOWERING BUSINESS OF THE YEAR Nominate one business or organization that supports the success of women in business. Self-nominations are accepted. NOMINEE Company/Organization: _________________________________________________________________________________________ Primary Contact Person: ________________________________________________________________________________________ Business Address: _____________________________________________________________________________________________ Phone: ___________________________________________ Email: ____________________________________________ Website: __________________________________________ Submit application via email, nhaberba@nwiwomen.com or Fax 219-226-0303 by May 29, 2015 Mark Your Calenders!!! Influential Women of Northwest Indiana October 15, 2015 FOR MORE INFORMATION CONTACT: Natalie Haber-Barker, nhaberba@nwiwomen.com, (219)226-0300