ICBM Legacy Award Nominee Form 2021

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* 1. Nominee Information

Name (first and last) *

Company *

Title *

Address

City *

State *

Zip *

Email Address *

Phone Number *

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* 2. List the full name you would like inscribed on the award if different than above.

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* 3. How many years has the nominee been in the industry?

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* 4. Please provide as detailed a career history as you can: (Years for major position changes are the most helpful.) Include the nominee's most memorable moment in banking, and outside activities and interests.

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* 5. List the nominee's key career accomplishment(s) or their personal highlights. These can include community support or banking-related activities.

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* 6. This nomination has been submitted by:

Name

Company

Title

Address

City

State

Zip

Email Address

Phone Number

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* 7. How would you describe the nominee? What makes them a good coworker or employee of the bank?

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* 8. If you’d like us to include a quote from you in the nomination, submit it here:

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* 9. How would the nominee like to receive the award?

In person at the 2021 Convention, on August 6th at the Awards Luncheon. (Nominee and one (1) guest will be invited for lunch complimentary, other family members, staff or friends will need to be registered and pay for lunch)

In person at the bank (We will call you to set up a date and time)