2012 Global Benefits Leadership Award Survey

The Global Benefits Conference in conjunction with the Global Benefits Magazine will be awarding a select group of individuals whose achievements have enhanced and brought innovation to the Global Benefits Industry. The Global Benefits Leadership Award will be presented at the 3rd Annual Global Benefits Conference held in Ft. Lauderdale/Miami, October 24-26, 2012.

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

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

Name:

Company:

Title

Address:

City/Town:

State/Province:

ZIP/Postal Code:

Country:

Email Address:

Phone Number:

2.Please select the award best reflects the nominee's achievements:

“Bismarck Award” ----- Given to an HR/Benefits Executive, Manager, or Administrator that recognizes extraordinary actions by the professional in the areas of HR/Benefit management, service delivery and design. Please provide an brief reason as to why you are nominating the individual as well as any supporting documentation (award, survey feedback, company recognition, article etc) that will support your nomination.

“Winston Churchill” Award ----- Given to a person(s) who have demonstrated going above and beyond industry expectations in their work that resulted in remarkable and exceptional results/achievement. A “never give up “ attitude existed in this person(s) actions similar to those exhibited by Sir Winston Churchill. This is meant to be given out to only one individual.

Provider Special Recognition -“Franklin Award” ----- Given either to an individual or company that provides, a service, support, insurance ,administration or other related employee benefit product. This award is to recognize very exceptional efforts and results. The results must stand up to objective measurement and with each nomination some sort of documentation again is requested.

3.Is the nominee an HR professional or a global benefits provider?(Required.)

HR Professional

Global Benefits Provider

Other (please specify)

5.Approximately how many employees does the nominee's company employ?(Required.)

6.Why do you feel that the person being nominated is a leader in the global benefits industry?(Required.)

7.What personal/professional characteristics does this nominee possess?(Required.)

8.What outstanding qualities make this nominee an influential leader in the industry?(Required.)

9.Please enter the following information about yourself:(Required.)