Nominate

Fields marked with a red asterisk (*) are required.

To be eligible for this award, the winner must live in or work in the Greater Rochester Area at the time of judging and be at least 60 years old as of September 1, 2021.

Nominations can be self-nominations or outside nominations.

Nominations are due by Sept. 24, 2021.

2021 Icon Honors Nomination

Nominee Information
Nominee Name*
First Last
Title*
Company Name*
Email*
Enter Email Confirm Email

Please list the nominee's email address, not the email address of the individual filling out the form.
Phone Number*
Address*
Street Address Address Line 2 City State ZIP Code
Size of Company*
Please describe why this nominee should be considered to receive the Icon Honors award.*
Nominator Information
Self Nomination*
Nominator's Name*
First Last
Title*
Company*
Nominator's Email*
Enter Email Confirm Email
Nominator's Phone*
Nominator's Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Notify me by email with special offers and events, including information about this event.
- Yes
Product Name
Total
$0.00
Billing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Credit Card

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name

2021 Icon Honors Nomination

Nominee Information

Nominator Information

Share this: