Nomination Form

Name of nominee*

First Last

Birth Date*

Name of Company*

Job Title*

Email of nominee*

Phone # of nominee*

Years in the industry*

Years at the company*

Name of nominator*

Email of nominator*

Phone number of nominator*

Why is this person a good candidate*

Max. 250 words highlighting innovations, outstanding accomplishments, commitment to company/industry, work with industry organizations etc.

All entries for the Top 10 Under 40 must be accompanied by at least one high-resolution photos of the nominee, preferably in the work environment.. Please upload the photos using this form or send the photos electronically to: Patrick Flannery, Editor, Glass Canada Magazine: PFlannery@annexbusinessmedia.com

Images*

Drop files here or

Accepted file types: jpg, png, Max. file size: 32 MB, Max. files: 3.

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