Award Nomination

Please complete the form below to nominate a deserving individual or company. If you have questions or would like to submit a nominee through email, please contact Keith Monfreda. Nominations for Ralph Cleveland Professional Agent, Young Insurance Professional, Company, and Company Person are due by March 21st. Nominations for Outstanding CSR are due by May 1st.

Award Nomination Form

* Indicates required field

Your Name *

First

Last

Your Email *

Nominee's Agency/Company Name *

Nominee's First & Last Name (if applicable) *

Email Address (Nominee or Main Contact) *

I am nominating this person/company for the following award: *

Ralph Cleveland Professional Agent of the Year Young Insurance Professional of the Year Company Award of Excellence Company Person of the Year Outstanding CSR of the Year

Please tell us why you're nominating this person/company: *

Would you like your nomination to remain anonymous? *

Yes, please keep my nomination anonymous. No, it's ok if the nominee knows I nominated them.

Submit

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