Award Nomination Form
Women in Insurance Technology and Innovation Awards are set to showcase the most exciting and effective innovations and technology implementations to disrupt and transform the insurance world. The awards will bring many great stories to the forefront of the insurance world, especially the ones where women led the industry during and post the COVID-19 pandemic addressing the unique and unforeseen set of challenges.
Sign in to Google to save your progress. Learn more
Email *
Select Award for Which you are submitting the Nomination *
Nominator Details
Full Name *
Email Address *
Company *
Job Title *
Nominee Details
Full Name *
First and last name
Email *
Phone number *
Date of Birth (Required for Young Insurance Woman of the Year Award)
MM
/
DD
/
YYYY
Company *
Job Title *
Describe the nominee's achievement that has made a positive impact in industry and for which she is being nominated. Please provide quantitative details as much as possible (Up to 300 words. This statement will be sent to judges to review as part of the judging process.) *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of Altaworld. Report Abuse
Google Forms