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.