To be eligible for consideration, nominees must have an Iowa connection, serve as a role model for young people as well as others in the insurance business, exhibit the highest standards of ethical conduct, and have significantly impacted the insurance industry. 

Required documentation to be included with this nomination form:

1. Nominee biographical information.

2. Summary of contributions to the insurance industry and community.

3. Other documentation to support guideline considerations, including letters of recommendation.

A nomination submission can be made in printed form but electronic submission in PDF format is preferred.  A completed nomination must be received by April 1st to be considered in the current selection cycle. 

Please print and complete this form Then send this nomination form and all required documentation to: 

Bob Fulwider

Wuestenberg Agency Inc.

PO Box 198

West Liberty, Iowa 52776

Telephone: (319) 627-2184

e-Mail: bfulwider@fai-wai.com