Nominate

Fields marked with a red asterisk (*) are required.

IMPORTANT ELIGIBILITY NOTE: To be eligible for this award, the nominee must live or work in the state of Maryland. If the nominee is not employed in Maryland, they must show a significant impact on Maryland through community work and mentoring. A winner is not eligible to win again the following year but can win a maximum of three times. Three-time winners are inducted into the Circle of Excellence. Honorees for this award are chosen by a panel of judges composed of past honorees.

Nominations are due by Feb. 3, 2024.

The fee for this nomination is $25, payable by credit card.

Nominee Name*
Prefix First Middle Last Suffix
Company/Affiliation*
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Enter Email Confirm Email
If there is another email address that should be included in communications about this event, include it here.
Comments
Please include the following so we can contact you if we are unable to reach your nominee.
Nominator's Name*
First Last
Nominator's Address*
Street Address Address Line 2 City State ZIP Code
Phone Number*
Nominator's Email*
Once the nomination form is submitted, an email will be sent to your nominee with the application link. The application must be completed to be considered for Top 100 Women.
Product Name
Total
$0.00
Billing Address*
The fee for this nomination is $25, payable by credit card. PLEASE NOTE: When entering your credit card payment information, it is important to note that in order for your card to be processed properly, the billing address needs to be the same as the address on file with the credit card you are using on this form. The most common error is due to the billing address not matching *exactly* to your statement.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Credit Card*

American Express
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MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name

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