About the Nominee

Nominee Name (required)

Company/Worksite (required)

How may we contact the Nominee if he/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 his or her 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 he/she lose weight?
Start exercising more?
Improve his or her blood pressure?
Change the health of others, including themselves?
Please include information regarding his or her success.
(200 words or less please)

Website

Upload a picture of the nominee (max file size 5mb).

Anti-SPAM