Owner Nomination Form 2026

Application Deadline: February 28, 2026
Awards Banquet Date: May 14, 2026

Owner Name:
Address: Address:
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Application Prepared By:
Email Address:
Phone Number: Phone Number: - ### - ### ####
Contractor Statistics
Total Contractor Work Hours in 2025:

Ex: 2000, 25000, 100000, 1000000
Fatalities in 2025:
Lost Work Day Cases in 2025:
Recordable Cases in 2025:
OSHA Citations in 2025:
Required Attachments

Please include your company name in the original filenames before submitting.

If you have trouble uploading pictures, please email them to kayla@mygcsc.com.
Please upload 3 work activity photos.
Please upload Company Logo.
Innovative Award

The Award for Innovations in Safety recognizes those who have developed and implemented innovative safety solutions in the workplace.
What innovative process, program, or device has your company developed and initiated in the past year? This is your opportunity to demonstrate that "special something" that sets your company apart from the others.

If you choose 'Yes' below, you will be required to submit an Innovative Award Nomination Form.
My company would like to be considered for the Award for Innovations in Safety.

My company would like to be considered for the Award for Innovations in Safety. Yes No
Sponsorship
Please include our company as a sponsor for the following:

Sponsorship does not include table.

Deadline for submitting Ad information is March 28, 2025.
Please select your method of payment:
I would like to...

A convenience fee of 3% will be charged on all card payments.
PO #
Cardholder Name (as shown on card):
Card Type:
Other:
Card Number:
Security Code:
Expiration:
Email Receipt to:
Billing Address

Billing Address Same as above
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Authorized Amount: $ Dollars . Cents
A convenience fee of 3% will be charged on all card payments.
I certify that I am the authorized holder and signer of the credit card referenced above. I certify that all information above is complete and accurate. I hereby authorized collection of payment for all charges as indicated above. Charges may not exceed the amount listed above in the "Authorized Amount" field. If additional charges are going to be authorized a new form will have to be completed.
Authorization of Card Use

Authorization of Card Use I agree
Cardholder Signature:

Draw or Type

Clear

Full Name
Verification of Information

Verification of Information I hereby certify that all information submitted in this application is true and correct to the best of my knowledge.
Confirmation:

Confirmation: I understand that I will receive a confirmation email upon submittal.

Owner Nomination Form 2026

Owner Nomination Form 2026

Contractor Statistics

Required Attachments

Innovative Award

Sponsorship

Please select your method of payment: