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Nomination Form:

11th Annual Bethune Leadership Recognition Banquet

(Presented by the Valdosta-Lowndes Metro Section of NCNW)

We are proud to honor outstanding women from Valdosta-Lowndes County and surrounding areas who have consistently demonstrated exceptional leadership and dedicated service to their communities.

Instructions for Submitting a Nomination

Please follow the steps below to ensure your nomination is complete:

Fill out all required fields marked with an asterisk (*).
Choose the appropriate nomination level (Community, Collegiate, or High School).
Submit the nomination fee to cover the nominee's banquet ticket:
- Community Nomination – $50
- Collegiate Nomination – $40
- High School Nomination – $40
If your nominee will have an escort, an additional $50 fee must be submitted by the nominee or escort (not the nominator) to cover the escort's ticket.
After submission and payment, a Nominee Information Packet will be sent via email.

All nominations and payments must be submitted by September 30, 2025 at 11:59 PM EST.

For questions or more information, please contact us at:

ncnwofvaldosta@gmail.com

Nominator Information

Nominator or Organization's name

Phone Number

Nominee Information

First name

Last name

Phone Number

Nominee's Address

Country/Region

Address

City

Zip / Postal code

Nomination Details

Nominee's Community level

Community, Collegiate and High School

How has the nominee provided outstanding leadership for their community?

Please provide specific examples.

Why do you think the nominee should receive this award?

Application Fee & Payment Information

Thank you for your nomination!

Please select the appropriate nomination level below and submit the corresponding application fee. The application fee covers the nominee's banquet ticket. After payment is received, the nominee will receive an information packet with event details.

Nomination Levels

Community Nomination$50

Collegiate Nomination$40

High School Nomination$40

Covers the nominee's banquet ticket.

Escort Fee:

If your nominee requires an escort, an additional $50 fee is required to cover escort accommodations.

Please note: The nominator is not responsible for this fee. It will be the responsibility of the nominee and/or the escort to submit this payment separately.

All nomination materials and payments are due by:

September 30, 2025, at 11:59 PM EST.