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Nominate a Candidate

If you are interested in being the next Man or Woman of the Year or would like to nominate someone you know, please fill out our official nomination form.

*required fields    

   Man & Woman of the Year Registration Form
YES! I will participate in the Man & Woman of the Year competition to benefit The Leukemia & Lymphoma Society. By sending in this form, I am pledging to raise a minimum of $1,500 for the fight against leukemia, lymphoma and blood cancers.
I would like to nominate a candidate for the Man & Woman of the Year.
Candidate/Nominator Contact Information*
Home Address*
City*
State*
Zip/Postal Code*
Phone*
Email*
Fax
Company
Title
Address
Work Phone
Work Fax
Email*
Local Newspaper
   Nominee Information
Name of Candidate Nominee
Address
City
State
Zip/Postal Code
Day Phone
Email







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