SD & Imperial County Heroes Awards Nomination Form
Nominator Name
*
First Name
Last Name
Nominator Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Nominator Email
*
example@example.com
Nominee Information
Please provide the following information of your Hero nominee.
Nominee Name
*
First Name
Last Name
Nominee Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Nominee Email
*
example@example.com
Nominator’s Relationship to Nominee
*
Does your nominee know they are being nominated?
*
Yes
No
Nominee Address
*
Street Address
Street Address Line 2
City
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Oregon
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South Dakota
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Texas
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Vermont
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West Virginia
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State
Zip Code
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Real Hero Category
*
Please Select
Animal Welfare
Corporate Hero
Disaster Services Hero
First Responder Hero
Gift of Life
Good Samaritan Hero
Service to the Armed Forces Hero
Youth Hero
Please describe what makes your nominee a Real Hero
*
Was this story covered by local media? If so, please share any links to online media coverage.
Are there others involved in this story that can be contacted? If so, please provide their names, phone numbers and email.
What is your relationship to this nominee?
*
How did you hear about this award opportunity?
Please Select
Friend
Radio
TV
Online
Red Cross website
Social Media
Other
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