Outstanding CSR of the Year
Competition Entry Form…continued.
Deadline for receipt
of all materials is
May 1, 2015
Education/Involvement/Achievement (attach additional paper if needed)
Please print or type.
Formal Education
Insurance-Related Education (within last 2 years)
Insurance Awards/Honors/Affiliations (within last 2 years)
Community Involvement/Awards/Honors (within last 2 years)
Significant Contributions to Business/Coworkers (within last 2 years)
Return this form with completed essay to:
Kansas Association of Insurance Agents • Attn: Faith Gibbs • 815 SW Topeka Blvd. • Topeka, Kansas 66612
The National Alliance • P.O. Box 27027 • Austin, TX 78755-2027 • 800-633-2165 • Fax: 512-349-6194
Fax 785-232-6817 • Email Deadline for receipt of all materials is May 1, 2015.
Email: [email protected] • [email protected]
Deadline for receipt of all materials is May 1, 2015
Awards
Nominees will compete first on a state level. Each state winner will automatically be entered into the national
competition.
State Winners: Framed Certificate of Achievement; state recognition; advancement to national competition
4 National Finalists: $500 cash award; national recognition; gold and garnet pin
National Award Recipient: $2,000 cash award; gold and diamond pin; employer receives a scholarship to a
National Alliance program; nominator receives a $1,000 cash award
2586-0115 TNA
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KANSAS INSURANCE AGENT & BROKER |January-February 2015|