Champions of Hope Gala Nomination
Please submit the name of a candidate for a donation champion award to be presented at the Champions of Hope Gala on October 8, 2022.
Nominee Name
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First Name
Last Name
Nominee Organization
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For (please check one of the following donation champion awards)
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Please Select
Outreach Partner
BMV/DMV Employee or Agency
Volunteer
Community Partner
Medical Examiner/Coroner
Funeral Director/ Professional
Donation Liaison
Physician
Nurse
Hospital Executive Leader
Hospital PR/Marketing
Hospital Spiritual Care
Hospital Social Worker, Respiratory Therapist, Donation Champion, etc.
Transplant Center Professional
Donor Hospital of the Year
Tissue Hospital of the Year
Placenta Hospital of the Year
OB/GYN Practice
Legacy Award
In 200 words or less, please tell us why this nominee deserves to be recognized for championing donation.
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0/200
Case or Donor ID, if known
Nominator Information
*
First Name
Last Name
Affiliated Organization
*
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Submit
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