Employee Achievement Award Winner Form

Please coordinate with your guest and the NPA representative who will accompany you to fill out the form below. This will help us make the necessary arrangements.

Award Winner Details

First Name *

Last Name *

Preferred Name if Different

Phonetic Pronunciation of Name (for award presentation) *

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

Winner Home Mailing Address

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

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

Departure Airport (if flight is preferred) *

Preference for Award Winner Payment *

Name as It Should Be Written on Check

If not sharing a room, do you prefer an adjoining room with your guest?

Do you prefer a (wrist) corsage or (pin-on) boutonniere for the Awards Banquet? *

Will you be accepting the award onstage, or will someone be accepting the award on your behalf? *

Do you prefer to transport your trophy home in your personal luggage, or would you like your trophy shipped? *

If shipping is preferred, please provide a mailing address 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 *

Guest Name

Let us know who you will be bringing with you as your guest.

First Name *

Last Name *

Preferred Name if Different

Email Address *

Cell Phone Number *

Departure Airport (if flight is preferred) *

NPA Representative Information

First Name *

Last Name *

Preferred Name if Different

Email Address *

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

Departure Airport (if flight is preferred) *

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

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.