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2018 Women of Industry Nomination Form
On Thursday, November 15, 2018, the San Rafael Chamber of Commerce will hold its 6th Annual, Women of Industry Luncheon & Marketplace at Peacock Gap Clubhouse in San Rafael and will recognize one Woman who has excelled in her field and made a significant contribution to the Marin business community. Women of Industry Award recipients are owners or leaders of a business, the driving force behind success through pioneering approach, business acumen, dynamism, innovation, audacity and tenacity. They have a genuine commitment to mentoring, pushing boundaries, motivating others, and relationship building with colleagues/employees, especially other women.

Completed nomination forms due to the Chamber, by 3 pm, Monday, July 16, 2018.

NOTE: Please notify your Nominee that she will be contacted about this nomination. Nominees are strongly encouraged to assist in filling out the application.

Email address *
Nominator
Your answer
Business/Organization
Your answer
Phone
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Name of Nominee
Your answer
Nominee Business
Your answer
Nominee's Phone Number
Your answer
Nominee's Email Address
Your answer
Number of years as business owner or professional in nominated industry/field (approximate)
Your answer
Is the Nominee a San Rafael Leadership Institute Graduate or Supporter?
Tell us about the Nominee. You are welcome to attach additional pages if your responses do not fit in the spaces below. Please include information about the nominee’s business or nominee’s work. For example, number of employees (or contractors), partners, business growth in annual/projected sales, the economic impact of their company and job, and list of professional organizations.
Your answer
Professional Accomplishments: Please tell us about how this Nominee has demonstrated outstanding skills, commitment, accomplishment and leadership in her chosen field.
Your answer
Empowering other Women: Please tell us how she has dedicated herself to the betterment of women in her industry.
Your answer
Challenges & Successes: Please include any examples of the challenges and successes that tell her story and how she overcame them.
Your answer
Tell Us Your Favorite Story About the Nominee
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A copy of your responses will be emailed to the address you provided.
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