2017 O&P Woman of the Year Nomination Form

Woman of the Year nominations are open to all women who work within the O&P profession. The award will be presented at a special event during the World Congress in Las Vegas.

Nomination Deadline: June 15, 2017. Any nominations received after the deadline will not be accepted.

Nominate a deserving leader within the O&P profession by filling out the form below

NOMINEE INFORMATION

Nominee First Name*	Nominee Last Name*


Nominee Email Address*

Nominee Company/Organization*

Nominee Job Title*

Nominee Phone*

Nominee Street*


Nominee City*	Nominee State*


Nominee Postal Code*	Nominee Country*

How has the nominee made significant contributions to O&P and its people? Introduce us to the nominee. How long has she worked in O&P? How is she received by colleagues, patients, or the others she works with on a daily basis? How is she a leader in what she does every day?*

How has the nominee demonstrated a passion for service and leadership in her professional and personal life? How does the nominee show her passion of service and leadership to her colleagues, patients and others? Does she volunteer for other organizations? Tell us about them.*

How has the nominee displayed determination and innovative thinking to solve problems? Give an example of when the nominee demonstrated determination or innovative thinking to positively affect her business or the profession.*

How has the nominee contributed to change for greater efficiency in her company that streamlines resources or improves morale? Explain what the nominee has done to improve efficiency in her business. Perhaps it was an action that worked to streamline resources or improve morale.*

NOMINATOR INFORMATION

Your First Name*	Your Last Name*


Your Email Address*

Your Company/Organization*

Your Job Title*

Your Phone Number*

Your Street Address*


City*	State*


Postal Code*	Country*