Event Registration:

CANADA AWARD NOMINATION 2024

Attendee Information

Complete Registration
NOMINATE A CANDIDATE

PLEASE NOTE: Nominee must reside in the CANADA Region.

All fields are mandatory, unless otherwise indicated.

About You (Nominator)

Please enter a first name
If you input more than 0 characters your First Name may not display properly

Please enter a last name
If you input more than 0 characters your Last Name may not display properly

Please enter a valid phone number including country code
If you input more than 0 characters your Phone may not display properly

Please enter a organization
If you input more than 0 characters your Organization may not display properly

Please enter a title/position
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About Your Nominee

Please enter a nominee first name
If you input more than 0 characters your Nominee First Name may not display properly

Please enter a nominee last name
If you input more than 0 characters your Nominee Last Name may not display properly

Please enter a nominee organization
If you input more than 0 characters your Nominee Organization may not display properly

Please enter a nominee job title
If you input more than 0 characters your Nominee Job Title may not display properly

Please enter a nominee email address
If you input more than 0 characters your Nominee Email Address may not display properly

Please enter a valid url
e.g. https://womeninpayments.glueup.com
If you input more than 0 characters your LinkedIn Profile may not display properly

If you input more than 0 characters your Nominee Phone Number may not display properly

Please enter a nominee address 1
If you input more than 0 characters your Nominee Address 1 may not display properly

If you input more than 0 characters your Nominee Address 2 may not display properly

Please enter a nominee city
If you input more than 0 characters your Nominee City may not display properly

Please enter a nominee country
If you input more than 0 characters your Nominee Country may not display properly

Please enter a nominee postal/zip code
If you input more than 0 characters your Nominee Postal/Zip Code may not display properly

Award details:

Please enter between 500 and 1,000 characters
If you input more than 0 characters your Please describe how the nominee meets the criteria for this award may not display properly

Please enter between 500 and 1,000 characters
If you input more than 0 characters your Briefly outline the nomineeโ€™s experience and most significant achievement(s) in her organization or within the payments industry in the area of leadership, mentorship, integrity, and diversity. (500 - 1000 max character) may not display properly
Click here to upload a file
Please upload a valid upload a profile picture of the nominee (max 1000 x max 1000 pixels, 2mb)
Select one or more options

References

Please enter a reference 1 first name
If you input more than 0 characters your Reference 1 First Name may not display properly

Please enter a reference 1 last name
If you input more than 0 characters your Reference 1 Last Name may not display properly

Please enter a reference 1 organization
If you input more than 0 characters your Reference 1 Organization may not display properly

Please enter a reference 1 job title
If you input more than 0 characters your Reference 1 Job Title may not display properly

Please enter a reference 1 email address
If you input more than 0 characters your Reference 1 Email Address may not display properly

Please enter a reference 1 phone number
If you input more than 0 characters your Reference 1 Phone Number may not display properly

Please enter between 300 and 500 characters
If you input more than 0 characters your Reference 1: What is the capacity in which they know the nominee? may not display properly

Please enter between 300 and 500 characters
If you input more than 0 characters your Reference 1 : What are the reasons that this reference supports this nominee? may not display properly

If you input more than 0 characters your Reference 2 First Name may not display properly

If you input more than 0 characters your Reference 2 Last Name may not display properly

If you input more than 0 characters your Reference 2 Organization may not display properly

If you input more than 0 characters your Reference 2 Job Title may not display properly

If you input more than 0 characters your Reference 2 Email Address may not display properly

If you input more than 0 characters your Reference 2 Phone Number may not display properly

Please enter a reference 2 : what is the capacity in which they know the nominee?
If you input more than 0 characters your Reference 2 : What is the capacity in which they know the nominee? may not display properly

Please enter a reference 2 : what are the reasons that this reference supports this nominee?
If you input more than 0 characters your Reference 2 : What are the reasons that this reference supports this nominee? may not display properly

If you input more than 0 characters your Reference 3 First Name may not display properly

If you input more than 0 characters your Reference 3 Last Name may not display properly

If you input more than 0 characters your Reference 3 Organization may not display properly

If you input more than 0 characters your Reference 3 Job Title may not display properly

If you input more than 0 characters your Reference 3 Email Address may not display properly

If you input more than 0 characters your Reference 3 Phone Number may not display properly

If you input more than 0 characters your Reference 3 : What is the capacity in which they know the nominee? may not display properly

If you input more than 0 characters your Reference 3 : What are the reasons that this reference supports this nominee? may not display properly

Contact Person

Please enter a valid phone number including country code
If you input more than 0 characters your Phone may not display properly

Please enter a first name
If you input more than 0 characters your First Name may not display properly

Please enter a last name
If you input more than 0 characters your Last Name may not display properly

If you input more than 0 characters your Title/Position may not display properly

Consent

This checkbox is mandatory