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IRELAND’S MOST POWERFUL WOMEN: TOP 25 AWARDS TRAILBLAZERS (For reference purposes only. All Nominations must be submitted online at https://top25.ie)

NOMINATOR INFORMATION Sal:

First Name:

Title:

Company/Organisation:

Address:

Town:

EIRcode (If applicable):

Country:

Telephone:

Email:

Executive Assistant Name:

Executive Assistant Email:

Last Name:

County / Postcode:

Executive Assistant Telephone:

How did you hear about the Top 25 Awards? Print Media Broadcast Media

Colleague

WXN Partner

WXN Website

E-vite

Letter from WXN

Other:

NOMINEE INFORMATION Sal:

First Name:

Last Name:

First Name Phonetics:

Last Name Phonetics:

Title:

Company/Organisation:

Address:

Town:

EIRcode (If applicable):

Country:

Telephone:

Email:

Date of Birth:

Executive Assistant Name:

Executive Assistant Email:

Executive Assistant Telephone:

County / Postcode:

Has the Nominee previously won the Award? Women who have won an Award twice are eligible for being inducted into the WXN Hall of Fame.

If yes, what year(s)? How many direct reports does the Nominee have? How many indirect reports does the Nominee have? To whom does the Nominee report? (Name, Title, Company)

Nominee’s Head Office Information Please fill in the following if Nominee’s head office information is different than above Company/Organisation: Address: Town:

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