2011 National Healthcare Reform Leadership Award
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The National Healthcare Reform Magazine(NHRM) recognize a select group of individuals each year whose achievements have enhanced and brought innovation to the voluntary benefits industry. Award recipients are dynamic individuals that have helped launch the industry forward in a positive direction. The National Healthcare Reform Leadership Award will be presented to these individuals as part of the NHRM Annual Meeting held October 26-28th, 2011.

* Nominations and all information provided in this form will be confidential and not shared with any third parties.

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1. Please enter the following information for the individual being nominated:

Please enter the following information for the individual being nominated: Name:
Company:
Title
Address:
City/Town:
State/Province:
ZIP/Postal Code:
Country:
Email Address:
Phone Number:

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2. How long has the nominee been promoting National Healthcare Reform?

How long has the nominee been promoting National Healthcare Reform? 1 - 3 Years

4 - 6 Years

7 - 10 Years

10+ Years

Not sure

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3. Approximately how many employees does the nominee's company employ?

Approximately how many employees does the nominee's company employ? 1 - 100 Employees

100 - 1,000 Employees

1,000 - 5,000 Employees

5,000 - 10,000 Employees

10,000 - 1000,000 Employees

100,0000+ Employees

Not sure

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4. Why do you feel that the person being nominated is a leader in the industry?

Why do you feel that the person being nominated is a leader in the industry?

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5. What personal/professional characteristics does this nominee possess?

What personal/professional characteristics does this nominee possess?

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6. What outstanding qualities make this nominee an influential leader in the industry?

What outstanding qualities make this nominee an influential leader in the industry?

7. Would you like to nominate another person?

Would you like to nominate another person? Yes

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2011 National Healthcare Reform Leadership AwardExit this survey

*1. Please enter the following information for the individual being nominated:

*2. How long has the nominee been promoting National Healthcare Reform?

*3. Approximately how many employees does the nominee's company employ?

*4. Why do you feel that the person being nominated is a leader in the industry?

*5. What personal/professional characteristics does this nominee possess?

*6. What outstanding qualities make this nominee an influential leader in the industry?