American Red Cross
Islands Chapter - Real Heroes Nomination Form
1. Nominee must live, work or be stationed in Fidalgo, Whidbey and the San Juan Islands.
2. Nomination Statement: Please explain why you are nominating the candidate for a Real Hero
award. Include any names of witnesses with contact information so we may verify the heroic act.
Please attach additional supporting materials such as news articles, police reports, etc.
3. Nominations must be received by February 10, 2013.
What is your relationship to the nominee?
Why are you nominating this person?
If possible, please provide names and contact information for additional people who can verify or support this nomination:
Please send this page, along with your nomination statement and supporting documentation to:
American Red Cross Islands Chapter; P.O. Box 249, Anacortes, WA 98221 or email
email@example.com or fax to 360-293-0101.
Do Not Fill This Out