CEBA - Awards Nomination Form

Nomination Form

The Colorado Ethics in Business Alliance Awards Event will be held Thursday, March 18, 2010 — 11:30 am-1:30 pm.

We in Colorado have plenty to celebrate in terms of corporate responsibility. Come and learn more about some of our own local for-profit and not-for-profit businesses and business leaders who demonstrate high ethical standards. Now more than ever it's important to celebrate their efforts, and their success!

$50 per ticket or $400 for a table of eight

There are two options for submitting this form:

Fill out the on-line form, below and submit it electronically
Download the .pdf form and mail or fax it to us.

ON-LINE NOMINATION FORM

NOMINEE INFORMATION

Nominee Name:

Company/Organization:

Company Contact:

Please be sure the person named above will be in charge of completing the documentation form.

Address:

City

ZIP:

Telephone #:

FAX #:

E-mail address:

AWARD CATEGORIES — Choose One
Business Ethics Award
Samaritan Institute Award
Daniel L. Ritchie Award

Brief description of nominee (use a separate sheet if needed):

Brief explanation for nomination (use a separate sheet if needed):

Your affiliation with the nominee, please choose one:

Employee	Customer	Vendor
Shareholder	Client
Consultant	Private Citizen
Other

NOMINATOR INFORMATION

Name:

Company/Organization:

Address:

City, State, ZIP:

Phone:

FAX:

E-mail:

*Denotes required field