Webster defines as hero as “one that shows great courage

2006 Nomination Form

Do You Know a Hero?

Everyday heroes are all around us. A hero might be someone who responded in an instant, has gone beyond the scope of their job to help another in critical need, possesses unique skills or is willing to put the life of another ahead of their own personal safety. It takes an unusual set of circumstances, as well as an exceptional set of characteristics, to be heroic.

Heroes could be:

- Professional responders such as firefighters, police officers or emergency workers

- Doctors or nurses

- Animals

- Military personnel

- Good Samaritan youth or adults

- 911 Dispatchers

- Educators/Teachers

Please note: Events must have occurred between January 1, 2004 and December 31, 2005 in one of the following counties: Oklahoma, Lincoln, Grady, Kingfisher or Eastern Caddo. If the event includes more than one hero nominee, they may be submitted as a group.

Nominee Information (Hero)

Name:_______________________________________________________________________________

Age (if under 18):_____________________

Business/Organization:___________________________________________________________________

Home Address:_______________________________________ City:_________________ Zip:_________

Work Address:_______________________________________ City:_________________ Zip:_________

Day Phone:____________________ Evening Phone:___________________ Fax:____________________

E-mail Address:_________________________________________________________________________

Suggested Hero Category:___________________________ Date and Location of heroic act:___________

Nominator Information (Name and contact information is required)

Name:________________________________________________________________________________

Business/Organization:___________________________________________________________________

Contact Address:_____________________________________ City:_________________ Zip:__________

Day Phone:____________________ Evening Phone:__________________ Fax:______________________

E-mail Address:_________________________________________________________________________

Incident Information

Please describe clearly, with as much detail as possible, the incident or circumstances and why you would like to see this person (or persons) honored for their heroic act. If you have news articles, incident reports, witness statements or any other supporting documentation, please submit them along with the nomination form to the address or fax number listed below.

Your statement will be reviewed by the HEROES selection committee. Each nominee will be notified to verify facts surrounding the event.

Incident Summary: ______________________________________________________________________

_______________________________________________________________________________________

Date submitted: ___________ Do you wish to remain anonymous? ___ Yes ___ No

For more information about the HEROES Breakfast on March 10, 2006, please call (405) 228-9581

or visit www.redcross.org/ok/okc.

Forms may be completed and submitted via email to nscott@arcok.org, faxed to (405) 228-3958

or mailed to:

American Red Cross of Central Oklahoma

Attention: HEROES

601 Northeast 6^th Street

Oklahoma City, OK 73104

The deadline for submission of nominations is January 20, 2006.

HEROES is sponsored by: