2021 Award Winner Funds Preference

    Person completing this form:

    Email of the person completing this form:

    If you prefer receiving a check, we will send it through UPS and require a signature for receipt. Please fill in this part of the form so we can fill out the check appropriately and send it to the right person:

    If you prefer having the funds wired to your bank, please fill in this part of the form so we can arrange for our bank to wire the funds to you:

    If you have any special instructions, please add them here: