Distinguished Women Honoree Info Form

Personal Info
Name * Required
Email * Required
Preferred Address(es) * Required
(Check at least one)
- Home Address
- Business Address
Home Address * Required
Street Address City State ZIP Code
Business Address * Required
Street Address City State ZIP Code
Phone * Required
Phone (Cell)
Fax
Printed Name * Required
I would like my name to appear in printed materials as follows:
Award Name * Required
I would like my name to appear on the award as follows:
Spouse's Full Name
Spouse's Vital Status
- Living
- Deceased
Spouse's Title, Company, or Profession
Professional Information
Business Name
Business Title
Business Address
Street Address City State ZIP Code
Business Telephone
Business Fax
Description of Responsibilities or Business
Additional Personal Data
Place of Birth
Birthday
Parents and/or Children's Names and Addresses
Please note child’s spouse’s name, if married.
Name Address Relationship
Education Notes (Schools/Colleges, Degrees, Membership in Honor Societies, and Awards)
Honors, Awards, and Citations of Which You Are Most Proud
Professional or Volunteer Awards and Achievements of Which You Are Most Proud
Please provide a sentence or two about why you are attracted by the Northwood philosophy, its programs, its students, the University itself, or a brief statement of your own personal philosophy or values. * Required
Disclaimer
Authorization of release of biographical info * Required
By checking this box, you authorize Northwood University to print your biographical information and photo in the Outstanding Business Leader Awards Gala program, website, and Northwood University’s press releases.
- I agree
Your Biography
Biography * Required
Please submit a biography of approximately 250-300 words.
Short Bio * Required
Please submit a shorter bio (25-50 words) for use in the group photo sheet.
Your Photo
Photo Upload * Required
Please upload a head and shoulders photograph (color preferred) for publicity and printed program use. Please use a .jpg file of at least 300 DPI.
Your Guest List
Please submit the names and addresses of individuals you would like to receive invitations to the Distinguished Women’s Gala event. We are happy to send as many as you wish. If you wish to host any of the individuals on your guest list, please indicate them as “complimentary.” Your guests will be so informed and we will bill you for any “complimentary” attendees.
Guest List
Name Address Relationship Hosting
Hotel RSVP
Name(s) * Required
Room Type Desired * Required
- King Bed
- Two Queen Beds
Arrival Date * Required
Departure Date * Required
Public Relations
Publication * Required
Please list newspapers, professional journals, alumni organizations, professional or volunteer association newsletters, or other publications/media contacts for news releases. Also list any public relations individuals or agencies you wish to have our office contact directly.

If you are unsure of an email address for a publication, please enter “N/A” in that space.
Publication Email Phone Contact Person
Comments
This field is for validation purposes and should be left unchanged.

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Name	Address	Relationship

Name	Address	Relationship	Hosting

Publication	Email	Phone	Contact Person

Personal Info

Professional Information

Additional Personal Data

Disclaimer

Your Biography

Your Photo

Your Guest List

Hotel RSVP

Public Relations