distinguished service nomination
About the Award
Recognizes an individual in
the independent industry
who has gone above and
beyond as a KAIA member
by volunteering, advocating
or enhancing association
membership or operations.
Open to all KAIA agent and
company members.
How to Nominate
You may self-nominate or
nominate an independent
agent by completing this
form and faxing it to KAIA
at 785-232-6817 or by
emailing your nomination
to [email protected].
kaia member you are nominating
Name of Member ___________________________________________________
Agency/Company ___________________________ City ____________________
Tell us about the member’s involvement with and contributions to the
association that make them deserving of this award ___________________
____________________________________________________________________
____________________________________________________________________
___________________________________________________________________
____________________________________________________________________
___________________________________________________________________
PERSON MAKING THE NOMINATION
Nominator’s Name(s) ________________________________________________
Phone _______________________ Email _________________________________
company rep of the year nomination
About the Award
Recognizes a company
representative who has
been a proponent of KAIA
and its member agencies,
enhanced the reputation of
the industry and promoted
the independent insurance
agency brand. Open to all
KAIA company members.
How to Nominate
You may self-nominate or
nominate an independent
agent by completing this
form and faxing it to KAIA
at 785-232-6817 or by
emailing your nomination
to [email protected].
22
COMPANY REPRESENTATIVE you are nominating
Name of Company Rep ______________________________________________
Company _____________________________ City ________________________
Tell us about the representative’s industry involvement and efforts to
promote/support independent agencies _______________________________
____________________________________________________________________
____________________________________________________________________
___________________________________________________________________
____________________________________________________________________
___________________________________________________________________
PERSON MAKING THE NOMINATION
Nominator’s Name(s) ________________________________________________
Phone _______________________ Email _________________________________
KANSAS INSURANCE AGENT & BROKER |March-April 2015|