Women of Distinction Nomination February 11, 2025 Hello! Thank you for completing the Women of Distinction Nomination Javascript must be enabled to properly view this page. * Indicates Required Field 1. Name of person submitting nomination * Title First Name * Last Name * Suffix 2. Address of person submitting nomination * (Street Address, P.O. Box, Company Name, c/o) Street Address, P.O. Box, Company Name, c/o Suite, Unit, Building, Floor, etc. Apartment, Suite, Unit, Building, Floor, etc. Apt Number City * State * New York New York Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip * 3. Telephone number of person submitting nomination * 4. Email address of person submitting nomination * Confirm Email:* Must match the corresponding email fieldMust match the corresponding email field 5. Name of woman being nominated * Title First Name * Last Name * Suffix 6. Address of woman being nominated * (Street Address, P.O. Box, Company Name, c/o) Street Address, P.O. Box, Company Name, c/o Suite, Unit, Building, Floor, etc. Apartment, Suite, Unit, Building, Floor, etc. Apt Number City * State * New York New York Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip * 7. Telephone number of woman being nominated * 8. Email address of woman being nominated * Confirm Email:* Must match the corresponding email fieldMust match the corresponding email field 9. I wish to nominate the above named woman for Assemblyman Al Stirpe’s Women of Distinction Award in the following category: * Education Community/Civic Affairs Business Health Care Volunteer 10. Biography of woman being nominated * User Name
