RAK Nomination Form

RANDOM ACT OF KINDNESS NOMINATION

Give a little light to someone with a FREE candle!
NOMINEE INFO

Nominate someone who should receive a Random Act of Kindness in the mail!
Nominee's Full Name*

First NameLast Name
Nominee's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Nominee's E-mail
Why are you nominating this individual?
Is there a special reason you feel they deserve this?
Any special message to include with the candle?
YOUR INFO
Your Email
example@example.com
How did you hear about this program?*
Other*
YesNo
Should be Empty:

RANDOM ACT OF KINDNESS NOMINATION