About the Nominee

    Nominee Name (required)

    Company/Worksite (required)

    How may we contact the Nominee if she is selected?
    Nominee Phone

    Nominee Email

    About You

    Nominated By (Your Name)

    Your Phone

    Your Email

    Relationship to Nominee

    In what way has this person improved their lifestyle?

    Please describe the person’s accomplishments in the applicable areas below.

    Increased Physical ActivityHealthier Eating Habits / Weight LossManaging heart-related risk factorsChanging the lifestyle, not only of themselves, but of those around them

    Personal story
    Why do you think this person deserves a Red Dress Award?
    Did they lose weight?
    Start exercising more?
    Improve their blood pressure?
    Change the health of others, including themselves?
    Please include information regarding their success.
    (200 words or less please)

    Website

    Anti-SPAM