Milton Cohen Leadership Award Winner Form

Please 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 Individual Who Will be Accepting Award Onstage *

Name, Exactly as It Should Appear on Trophy (with NPA name if applicable) *

Email Address *

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

Departure Airport *

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

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

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

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.