Nominee Contact Information
Nominee Name
Address
City
State
Zip
Daytime Phone
Description of Nominee
A typed, detailed description, no more than 1 page in length, of the nominee’s activities that have prompted you to make this nomination.
Description
Upload any additional information such as a news story, photos, or other supporting documents
Max. size: 256.0 MB
Nominator Contact Information
Your Name
Address
City
State
Zip
Cell Phone
Signature (Type your full name)
Photographs taken at the event may be used for promotional/marketing purposes of Interfaith Caregivers of Washington Co., on our website, in printed materials, or in any other way deemed appropriate by Interfaith. If you or the person or organization you are nominating do not consent to the use of photographs, please check the box below.
Photo Usage
If you have any questions, please call Janean Brudvig at 262-365-0902
