WOD Nominee Form

Contact Information

Contributions to Community

Please describe three (3) contributions to the Martin County community that you have made. (Maximum 750 words)

Awards Received

Please list any awards, recognition or tributes you have received for your contributions in the
community, your business, or both:

Professional Organizations

Starting with the most recent, please list at least three (3) community, civic and/or professional organizations with which you are or have been associated during the past ten (10) years: (Maximum 500 words.)

Important information for nominee: Soroptimist International of Stuart reserves the right to
place you in another category if your qualifications and community contributions fit more
appropriately into another category. You and your nominator will be notified of the change.

Soroptimist International of Stuart reserves the right to disseminate and utilize your photograph
for public relations purposes. By submitting this form, you are acknowledging your agreement to
the use of your photograph.

Note: No materials in addition to the Nominator's Form or Nominee Profile Form will be
considered. Please double-check the information provided and email to sistuart@yahoo.com.