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Women of Distinction identifies women who have made a difference in the Illinois Valley and who are representative role models as leaders in their fields and community. Honorees will be profiled in the Illinois Valley Living Magazine’s September issue and recognized at an awards luncheon in the fall. Date and location to be announced. Please fill out this form completely (use additional paper if necessary) and return by August 1, 2016. Additional forms can be downloaded by visiting www.illinoisvalleyliving.com. Today’s date:__________________________________________ Education:
A. Nominee’s Personal Information Name ___________________________________________________________ Organization/company/corp. _______________________________________ Title_____________________________________________________________ Phone ___________________________________________________________ City of residence__________________________________________________ E-mail __________________________________________________________ Hometown (childhood) ____________________________________________ Date of birth _____________________________________________________
______________________________________________ ______________________________________________ ______________________________________________ Family: ______________________________________________ ______________________________________________ Please include bio/résumé/vita
B. Achievements In the space below, please describe the nominee’s greatest personal, professional or job-related achievement. Honors or awards can be included as well as examples of a challenging problem solved, a major project completed or a product produced. ______________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________ C. Nominator *Name _____________________________________________________ Title _______________________________________________________ Organization _______________________________________________ Phone ______________________________________________________ *Email: _____________________________________________________ *Must include to be informed if your nominee has been selected
Presenting Sponsor
DEADLINE FOR NOMINATION: August 1, 2016 Mail: Women of Distinction % Bureau County Republican P.O. Box 340 Princeton, Illinois 61356 Attn: Terri Simon or Email: tsimon@bcrnews.com Subject line: Women of Distinction
Keynote Sponsor
Major Sponsors
Liberty Village
Peru 815-224-2200
Streator 815-672-1900
Princeton 815-875-6600
www.simplythefinest.net
St. Margaret’s Hospital
Illinois Valley Living
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