Arizona Women of Inspiration Night Friday, September 5 @ 5:30pm – Nomination Form

1. Arizona Women of Inspiration Night Friday, September 5 @ 5:30pm – Nomination Form Nominee’s Name: ________________________ Phone Number: __________________________ Email Address: __________________________ Your Name: _____________________________ Phone Number: __________________________ Email Address: __________________________ I believe _________________________ is a Woman of Inspiration because ____________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ______________________________________________________________________ _________________________________________________________________ ______________________________________________________________ ____________________________________________________________ ___________________________________________________________ _____________________________________________________________ _______________________________________________________________ Selections will be made based on the following criteria: outstanding individual accomplishments, overcoming obstacles and/or inspiring others. Winners will be notified one week prior to the day of the reception and game. If you need more room to write your nomination, please attach an additional form. Nominations are due 8/27/08. Fax Form to 602.379.7873 or Email to jlamanna@phoenixmercury.com