Arizona Historical Society: 48 Most Intriguing Women of Arizona

Nomination Form

The Governing Board invites you to submit Nominations for the 48 Most Intriguing Women of Arizona. Please use one nomination form for each nomination. Self-nominations are accepted. You may attach two additional pages.

Nominee Information

Nominee Name:

Nominee Organization/Company (if applicable):

Nominee Organization Title/Role (if applicable):

Nominee Address: City: State: AZ ZIP:

Nominee Home/Cell Phone: Nominee Business Phone:

Nominee Email:

Nominator Information

Your Name:

Your Organization/Company (if applicable):

Your Organization Title/Role (if applicable):

Your Address: City: State: AZ Zip:

Your Home/Cell Phone: Your Business Phone:

Your Email:

Nomination Categories

Please check the category that best fits the area of achievement/contribution of the person you are nominating. (Please select only one category). 48 Women reserves the right to confirm correct category.

Education Sports

Arts/Entertainment Government/Legislative/Judicial

Environmental Cultural Development/Social Change

Business/Economics Science/Medicine/Technology

Family/Community Philanthropy

Military/Law Enforcement General


Please answer all of the following questions as completely as possible:

1.  Why did you nominate this person?

2.  Describe the nominee’s achievement or contribution and its impact:

3.  Indicate the timeframe in which it occurred and if it is an ongoing effort or achievement:

(please be specific)

4.  How does your nominee “make a difference” (examples might include: outstanding leadership, scientific discovery or breakthrough, literary or artistic contribution, advancing the culture, etc.)

The nominee meets the following: (Please check all that apply.)

Asian or Pacific Islander Woman African American Woman

Latina Woman Native American Woman

Caucasian Woman Disabled Woman

Woman under 35 Woman over 55

Other (please explain):

Your signature grants 48 Women the right to copy, reprint, quote or publish information contained herein as part of its awards program or other public communication. Nomination materials become the property of 48 Women and will not be returned.

Signature of Nominator: Date:

Please email this completed form to Connie Robinson at: , or fax to: 602-896-9899.

1 / 48 Women Nomination Form