PowerUp Hero Show Nomination Form

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PowerUp Hero Show Nomination Form

Welcome and Thank You for being here. We look forward to hearing about your nomination story, whether it is you or someone else. Stories change lives. #PowerUpHero

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* Indicates required question

Email *

Your email

Are you nominating yourself or someone else? *

Myself

Someone else

Other:

Nominator Full Name (Your Name) *

Your answer

Hero Full Name *

Your answer

Hero Email Address *

Your answer

Please tell us why this person is a #PowerUpHero. Write as much or as little as you like. *

Your answer

Thank you! Your nomination is appreciated, more than you can imagine. Please click submit below.

A copy of your responses will be emailed to the address you provided.

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