Please read and complete each section carefully
Section 1 refers to the Nurse's information. Section 2 refers to the Presenter that will assist with the presentation of the medal. NOTE: NURSES AND PRESENTER MUST BE PRESENT TO RECEIVE THE MEDAL, UNLESS THE NURSE IS WORKING AND CANNOT ATTEND FOR THAT REASON. Presentation will be Friday, June 10, 2022 during Opening Ceremony of the Alabama State Games 7:30 PM National Peanut Festival, Dothan, Alabama. Those Nurses who are working and cannot attend will receive their medal upon verification at a later date.
Section 1: NURSE
Please complete Section 1 with the information about the Nurse that will be honored.
Name
*
First Name
Last Name
Nurse's Place of Employment and Title (can be hospital, practice, nursing home, home health, etc. and any level of nursing)
*
E-mail
*
Phone Number
*
-
Area Code
Phone Number
Section 2: PRESENTER
Section 2 is for the person who will actually assist in making the presentation of the Our Hero Medal to the Nurse. The presenter will give their nurse the medal during the medal ceremony. The presenter can be anyone. The nurse can fill this form out and select the presenter or the presenter can fill this form out for a nurse they love or has taken care of the presenter in some capacity. We ask both the nurse and the presenter to be present at Opening Ceremony, Friday, June 10, 2022 National Peanut Festival Fairgrounds in Dothan which is when/where the presentations will take place.
Name
*
First Name
Last Name
E-mail
*
Phone Number
*
-
Area Code
Phone Number
The ASF Foundation, a non-profit 501(c)3 organization, was founded in 1982 at the request of the United States Olympic Committee. The ASF Foundation is responsible for hosting the Alabama State Games, an annual multi-sport Olympic-style event. Our foundation also serves as a statewide mentor organization for teaching our youth the importance of academics, athletics, healthy lifestyles and good citizenship.
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