REAL HERO NOMINATION FORM

Please fill in the appropriate fields and click Nominate My Hero>>

Award Category for Consideration

Please check all that apply

Good Samaritan ADULT Hero
Good Samaritan YOUTH Hero
Medical Hero
Firefighter Hero
Law Enforcement Hero
Disaster Relief Hero
Military Hero
Animal Rescue Hero
Workplace Hero
Water Safety Hero

Tell Us Who You Would Like to Nominate:

NOMINEE First and Last Name*

Nominee Address*

Nominee City*

Nominee Zip Code*

Nominee Daytime Phone*

Nominee Evening Phone

Nominee E-mail

Nominee Employer and Phone

Nominee County of Residence

Location Where Event Took Place*

Period of Time or Date of Event*

Tell Us About Yourself

(Person Making Nomination)

NOMINATOR First and Last Name*

Address*

City*

Zip Code*

Daytime Phone*

Evening Phone

E-mail

Relationship to Nominee*

Employer and Phone

Nomination:

Please state why you are nominating the candidate for the American Red Cross Real Heroes Award. Nominee should meet the following criteria to be considered for the Real Heroes Awards. 1.) Must be a resident of or employed in New Mexico. 2.) Must have performed his/her heroic act between January 1, 2010 and December 31, 2010. Nomination Statement. Please state clearly and in as much detail as possible the incident which occurred and why this person or group deserves a Real Hero Award. Please include any names and contact information of anwitnesses we may call to verify the event or additional items such as newspapers articles, awards, commendations, etc. for the selection committee to review. Please provide as much information as possible for Real Heroes Selection Committee.

Your Real Hero Nominee:

May be a friend or family member, a neighbor, co-worker, a firefighter, a member of the military or a police officer. The nominee may be a professionally trained life saver or simply a Good Samaritan. Heroes must either live or work in New Mexico; the heroic action may have taken place outside the state of New Mexico. (Example: A local resident who saved a life while on vacation in Arizona.)

Description of Heroic Action:*