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Members are welcome to nominate themselves or a non-member, as long as the nominee will be under the age of 40 as of June 1 2014.

Please fill this form out if you are a member nominating yourself.

* indicate required information.

Nominee Information

First name*

Last name*

Year of birth*

Email*

Phone*

Address

Street 1*

Street 2*

City*

State*

Postal code*

Country*

Place of employment*

Title*


Field of work

Please provide a brief, one-sentence description of the nominee, including her/his position, organization, and primary activity. *
(Limit 160 characters. Excluding spaces.)

How has this candidate displayed uncommon business acumen, leadership, or commitment to development that enhances quality of life? Please provide specific examples of how the candidate has made a difference in his or her profession.*
(Limit 1,000 characters. Excluding spaces.)

How has this candidate demonstrated a fresh approach to community building?*
(Limit 1,000 characters. Excluding spaces.)

Is there anything else you would like to add?
(Limit 1,000 characters. Excluding spaces.)