American Red Cross “Salute to Everyday Heroes”

Nomination Deadline December 31, 2006

 

Hero’s Name___________________________________________________________________________

 

Address ______________________________________________________________________________

                    Street                                                  City                             State                                   Zip Code

 

Home Phone _________________________ Work Phone______________________________________

 

Employer _____________________________________________________________________________

 

Award Categories (please check one)

                š Fire                                                                    š Youth Good Samaritan (17 years and under)

                š Law Enforcement                                            š Adult Good Samaritan

                š Emergency Response                                     š Workplace Good Samaritan        

                š 911 Dispatch                                                   š Team Good Samaritan

                                                                                                                                               

An individual or a group of individuals, acting together in a lifesaving situation, may be nominated for an award in any category.  A community advisory committee will review the nominations and select the winners.  Acts of heroism must be performed within established guidelines and meet the following criteria to be considered for the Everyday Heroes Awards.

1.        Nominations should be related to fire, rescue, humanitarian or other lifesaving acts.

2.        Nominee must have been a resident of Calhoun or Branch County when the rescue occurred or the rescue must have occurred within Calhoun or Branch County.

3.        Timeline for Heroic Act:  January 1, 2005 through December 31, 2006

4.        Please attach reports, news articles, or names of witnesses we may call to verify the event.  Also attach the name and phone number of the victim.  This information is very helpful to the selection committee.

 

Nomination Statement:  Please return this form along with a sheet of paper describing as fully as possible why this person(s) should receive an award as an Everyday Hero.  Remember to include any reports, news articles or names of witnesses.

 

Nominated By _________________________________________________________________________

 

Address_______________________________________________________________________________

                  Street                                    City                                         State                                       Zip Code

 

Daytime Phone___________________________ Evening Phone_______________________________

 

Relationship of Nominator ____________________________________________________

 

Please return nomination form by December 31, 2006 to:

American Red Cross

Attention:  Angie Gresley

P.O. Box 1380             or            14600 Beadle Lake Road

Battle Creek, MI  49016              Battle Creek, MI  49014

Phone:  269-962-7528

Fax:  269-962-0010

Toll Free: 1-888-919-1011