Honorary Service Awards - Nomination Form

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Descriptions of each Award category can be found on our website. Submit one Nominee per response. Multiple responses may be submited, if you have more than one Nonimee.

Email *

Your Name - First and Last *

Nominee Name - First and Last 0r Organization Name *

Please tell us why you are nominating this individual or organization.

Please provide as much detail as possible to let us know why you are nominating this individual or organization.

Reason *

Proposed Award or Donation (Tribute or Memoriam)

The committee will consider all nominations. The HSA Selection Committee will select one or more recipients. Donations can be made by the person or organization making the nomination or they can be nominated to be considered by our HSA Selection Committee.

Select One of the Following *

Proposing an Award

Proposing a Tribute or Memoriam Donation

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