2023 Stars of Life Nomination Form
This is a wonderful opportunity to recognize members of your staff by registering them for this event. Equally important, we hope that you will attend as their host for the event. Deadline for nominations is August 19, 2022. Please complete one form per STAR and no more than TWO from your organization. This is step one.
Star's First and Last Name
First Name
Last Name
Star's Title
Length of Service (years):
Sponsoring EMS Agency
Sponsor's (Nominator's) Name and Title
Sponsor's Phone
Please enter a valid phone number.
Sponsor's Email
example@example.com
Please summarize the reason(s) this individual is being honored as a Pennsylvania Star of Life. This information will be used in the dinner program. Review and spell check prior to submission.
Please describe the reason this person is being honored:
Describe his/her work experience:
Describe a distinguishing personal trait:
Describe notable personal interests or accompishments:
Step 2: Register for the Stars of Life Dinner upon submission
Submit
Should be Empty: