2020 Wisconsin Child Passenger Safety Hero Nomination Form

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Wisconsin Child Passenger Safety Heroes is your opportunity to recognize an exceptional individual or group that has contributed to the field of Child Passenger Safety in Wisconsin.

All nominees will be recognized during the 2020 Governor's Conference. Heroes do not have to attend to be recognized.

Nominator Information

First Name:

Last Name:

Email Address:

Hero Information

Name of Individual or Group:

Email Address:

City:

State:

Zip Code:

Hero's Affiliation: Please provide us with the name of the organization they work or volunteer for.

My nominee is a hero because:

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