Diversity and Inclusion Nomination Form Please complete this form on or before January 14, 2022. You may submit up to 3 nominees.Your Name(Required) Your Company(Required) Your Company's Address Street Address City State / Province / Region ZIP / Postal Code Your Title(Required) Your Email(Required) Your Phone Number(Required) Who are you nominating? (Choose one)(Required) I am submitting a nomination on behalf of my company/employer. I am submitting a nomination on behalf of a business partner with whom I work. NOMINEE INFORMATIONNominee Name(Required) Nominee Company(Required) Nominee Title(Required) Nominee Email(Required) Entry Category (choose one)(Required) Retailer Wholesaler/Distributor Suppliers/Vendors/Solutions Providers/Sales and Marketing Agency Associations Please furnish information for all of the following fields:In 2000 characters or less, detail your nominee’s demonstrated accomplishments, including convincing details of demonstrated achievements, such as building and fostering impactful D&I programs and initiatives that clearly demonstrate efforts to initiate and build greater diversity and inclusion related to sex, gender, race, ethnicity, disability and age during the past year. This can also include relevant D&I awards and accolades from within and outside of the industry. Please note that if your icon wins, this is the description that will run in the March 2022 issue.(Required)2000-character maximum.May we contact the person listed as the primary contact for this submission for additional information or an interview to support of the submission? Yes No If no, please list the key contact person with whom we should work if we have questions about your entry.Name: Email: Phone Number: Please upload 1-2 high resolution photos to support your nomination. Drop files here or Select files Accepted file types: jpg, jpeg, png, pdf, Max. file size: 8 MB, Max. files: 2. CAPTCHAThe deadline for nominations is January 14, 2022. Questions? Email President and Publisher, Stephanie Reid, at [email protected] for more information. PhoneThis field is for validation purposes and should be left unchanged. Δ
