Customer Award Winner Form

Please fill out the form below. This will help us make the necessary arrangements.

Customer Winner Details

Name and Title of the Individual(s) Who Will Be Accepting the Award Onstage *

Preferred Name(s) if Different

Phonetic Pronunciation of Individual(s) Who Will be Accepting Award Onstage *

Acceptor Email Address(es) *

Acceptor Cell Phone Number(s) *

Official Customer Organization Name, Exactly as It Should Appear on Trophy and in Video *

Would the award acceptor prefer a (wrist) corsage or (pin-on) boutonniere for the Awards Banquet? *

Optional award acceptor: (wrist) corsage or (pin-on) boutonniere

Will an award acceptor be transporting the trophy home in their personal luggage, or should SourceAmerica ship the trophy separately? *

If shipping is preferred, please provide a mailing address and contact name for the package.

Media Participation Preferences

As part of Award recognition, there may be opportunities for interviews or promotional features. To help us plan media opportunities in a way that feels comfortable for you, please indicate which interview formats you are open to.

Preferences *

If Applicable, Name of Primary Media Contact/Spokesperson at Organization for Potential Award-Related Interviews or PR Opportunities

NPA Nominator

Full Name of Person from NPA Who Will be Attending Xforce *

Preferred Name if Different *

Email Address *

Cell Phone Number (Note: We may text this number with on-site updates.) *

Preference for NPA Award Payment *

Name/Organization as It Should Be Written on Check

Media Participation Preferences

Preferences *

Name of Primary Media Contact/Spokesperson at Organization for Potential Award-Related Interviews or PR Opportunities *

Upload: High-Res Logo of Nonprofit Agency *

A high-resolution logo ensures optimal quality for printing and digital display. Please upload a logo file with a minimum resolution of 300 DPI (dots per inch) in a common format such as PNG, JPEG, or SVG. If unsure, a high-resolution image typically appears sharp and clear when zoomed in.

One file only.
2 MB limit.
Allowed types: gif, jpg, jpeg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.