Real Heroes Nomination Form
| Nominator Information |
Your Nominee |
| Name: ____________________________ | Name: ____________________________ |
| Business: ____________________________ | Occupation: _________________________ |
| Address: ____________________________ | Address: ____________________________ |
| City: ____________________________ | City: ____________________________ |
| Zip: _____________ | Zip: _____________ |
| Day Phone: __________________________ | Day Phone: __________________________ |
| Evening Phone: _______________________ | Evening Phone: _______________________ |
| Award Category (Please Circle
One) |
|
| • Fire Rescue | • Military |
| • Law Enforcement | • Animal Rescue |
| • Medical | • Education |
| • 911 Dispatch | • Industrial Safety |
| • Adult Good Samaritan (20 and Over) | • Good Neighbor |
| • Youth Good Samaritan (19 and Under) | • Blood Donor |
Nomination Statement: On a separate page, please state why you are nominating this candidate for a Real Heroes Award. Include any supporting reports, news articles or names of witnesses we may call to verify the event.
Nomination Deadline: September 7, 2001
Please print or copy this Nomination form and Mail to:
Real Heroes Breakfast
American Red Cross
Onondaga-Oswego Chapter
220 Herald Place
Syracuse, NY 13202
OR Fax: (315) 234-2233
• Return to the Real Heroes page