How to Submit A Nomination

To be eligible for consideration, nominees must have an Iowa connection, serve as a role model for young people as well as others in the insurance business, exhibit the highest standards of ethical conduct, and have significantly impacted the insurance industry.

Please fill up the form below to submit your nomination by March 1st to be considered in the current selection cycle. New nominations not selected in the current cycle will be remain eligible for five years.

Step 1 of 3

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Nominee Contact Information
Name*
First Last
Address
Street Address Address Line 2 City State ZIP Code
Day Phone
Cell Phone
Email
Is the nominee deceased?*
- Yes
- No
If so, who would accept the award if inducted?

Nominee Biographical Information*
Summary of contributions to the insurance industry and community.*
Other documentation to support guideline considerations, including letters of recommendation.*
Drop files here or

Accepted file types: jpg, png, pdf, docx, csv, xls, xlsx, doc.

Nominator Contact Information
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Day Phone*
Cell Phone*
Email*
Phone
This field is for validation purposes and should be left unchanged.

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Send updates and comments to Robert D. Conroy, CPCU, CIC