40 Under 40 Nominations Form

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NBA’s 40 Under 40 for 2017-18

40 UNDER 40 NOMINATIONS' FORM

DEADLINE: MAY 19, 2017

Please use this form to provide information for the nominee and yourself. All timely submissions will be reviewed by the committee and final decisions will be made in June. Please complete the form in its entirety and include all relevant and requested information. Incomplete submissions will not be considered. If you have any questions, contact the 40 Under 40 Committee at [email protected] Please submit one form per nominee. Please submit this form, along with the nominee's Resume and head-shot to [email protected] by May 19, 2017. All attachments should be in one email. Please type the nominee's name in the subject line. AWARD RECIPIENTS WILL BE HONORED DURING THE NATIONAL BAR ASSOCIATION ANNUAL CONVENTION TAKING PLACE JULY 29 - AUG 4, 2017

NOMINEE INFORMATION: * Nominee’s Last, First Name

* City in which Nominee resides

* Nominee’s state of residence

* Nominee’s mailing zip code

* Nominee’s preferred phone number

* Nominee’s preferred e mail address

* Nominee’s current employer, if any

* Nominee’s current job title, if any

* In 500 words or less please explain why this person should be considered for this honor?

500 words

40 Under 40 Nomination Form

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NOMINATOR’S INFORMATION: * Nominator’s Last, First Name

* City in which Nominator resides

* Nominator’s state of residence

* Nominator’s mailing zip code

* Nominator’s preferred phone number

* Nominator’s preferred email address

* In 75 words or less please explain your business, personal, familial, or other affiliation with the nominee, if any?

* Are you a member of the National Bar Association?

□ Yes □ No * Indicates Response Required

PLEASE SAVE THIS FORM AS A PDF. YOU MAY NEED TO SELECT PRINT, THEN SELECT THE PRINT OPTION "SAVE AS PDF".