Hospice Hero Award

Hospice Hero Award

Nomination Form for National Recognition
The national Hospice Hero award recognizes an individual who significantly strengthened his/her local hospice regatta and/or the local non-profit hospice that benefits from the regatta. Their example demonstrates both commitment and achievement, and it inspires others to make comparable efforts.
Nominee:

First NameLast Name
Email Address:
example@example.com
Phone Number:

Area CodePhone Number
Please explain why you selected this person to receive your local Hospice Hero award. Tell us why you think he/she deserves national recognition; please be specific about time commitment, level of responsibility assumed, and achievement.
Details
Nominated by:

First NameLast Name
Your Hospice Regatta Name and Location:
Your Email Address:
example@example.com
Your Phone Number:

Area CodePhone Number
Please provide the name and contact information for one other person we can talk to about your Hospice Hero's achievements.
Today's date:

MonthDayYear
Date
Should be Empty: