2011 Self Funding Leadership Award

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The Self Funding Employers Association (SFEA), in conjunction with the Self Funding Magazine (SFM), recognize a select group of individuals each year whose achievements have enhanced and brought innovation to the self funding industry. Award recipients are dynamic individuals that have helped launch the industry forward in a positive direction. The Self Funding Leadership Award will be presented to these individuals as part of the SFEA and SFM 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:

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 self funded medical plans?

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?

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 self funding industry?

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* 5. 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?

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* 7. Would you like to nominate another person?

Yes