Nominate a deserving individual/Company today!

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 Libby Gardner at Libby@PIAIndiana.com. Nominations for Ralph Cleveland Professional Agent, Young Insurance Professional, Company, and Company Person are due April 8th. Nominations for Outstanding CSR are due by May 1st.

2019 award Nomination Form

* Indicates required field

Your Name *

First

Last

Your Email *

Nominee's Agency/Company Name *

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

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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