NLBWA-LA’s Honoring Latinas In Business Awards
 Please complete the following form:

1.  
 Latina Business Owner's Name:
 
 
2.  
 Company Name:
 
 
3.  
 Industry/Field:
 
 
4.  
 Address:
 
 
5.  
 City:
 
 
6.  
 State:
 
 
7.  
 Zip:
 
 
8.  
 Phone:
 
 
9.  
 Email:
 
 
10.  
 Website:
 
 
11.  
 You are nominating this person, because she:
 
Is dedicated to giving back to her community
Has demonstrated business growth in the last year
Has unique leadership and mentorship abilities
Has overcome tremendous adversity
Inspires and encourages others
Succeeds in a male-dominated industry
Plays a key role in a ground-breaking career
12.  
 Nominated By:
 
 
13.  
 Your Company (if different)
 
 
14.  
 Email (if different)
 
 
15.  
 Phone (if different)