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Red Cross Heros breakfast
7th Annual Community HEROES Sponsors
CLARA BARTON EVENT SPONSOR - $5,000
Full day educational program for 15 employees –includes training patterned to meet your needs, luncheon, First Aid Kit for each participant (held at chapter house or your facility).
Name and Logo will be featured on all printed material, media releases and will be displayed at the breakfast.
Tickets for 16 people to the breakfast.
COMMUNITY HEROES AWARD SPONSOR - $1,000
Will present award to one of our HEROES.
Name and Logo will be featured on all printed material, media releases and will be displayed at the breakfast.
Tickets for 8 people to the breakfast
COMMUNITY HEROES PARTNER- $500
Name and logo will be printed on all printed material, media releases and will be featured on programs at the breakfast.
Tickets for 4 people to the breakfast.
COMMUNITY HEROES FRIEND - $250
Name featured on program at the breakfast
Tickets for 2 people to the breakfast.
COMMUNITY HEROES BREAKFAST TICKET - $25.00
SPONSORSHIP FORM
Name: ______________________________________________________________________________
Address: _____________________________________________________________________________
Phone: __________________________________ Fax: ______________________________________
Email: ______________________________________________________________________________
Contact Person: ______________________________________________________________________
Sponsorship Level: ___________________________________________________________________
Check is enclosed: _________________Please Invoice after February 15, 2010: ________________
In order for your name to be on printed material we need confirmation by March 3, 2010.
Thank you for your support of the American Red Cross Ashtabula County Chapter.
The American Red Cross is defined as a Charitable organization in accordance with Section 501 © (3) of the Internal Revenue Code, and as such authorized to accept tax-deductible donations
AMERICAN RED CROSS – ASHTABULA COUNTY CHAPTER
433 CENTER STREET
ASHTABULA OHIO 44004 PHONE -440-998-1020 FAX-440-998-2995
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2010 NOMINATION FORM
PLEASE PRINT OR TYPE
All nominations must be received no later than Friday, February 26, 2010. Forms may be mailed or faxed to: 433 Center Street, Ashtabula, Ohio 44004. Fax number: 440-998-2995. Please note: Events must have occurred between January 1, 2009 and December 31, 2009
in Ashtabula County. If the event includes more than one hero nominee, they may be submitted as a group.
Nominator Information (Required)
Name ____________________________________________________________________
Address __________________________________________________________________
City State Zip _____________
Phone (Day) (Evening) __________________________
Email _____________________________________________________________
HERO CATEGORIES (Please select one)
Courageous/Lifesaving Award (Public) - Nominee performed an extraordinary courageous and/or lifesaving act or an act having community impact. Nominee is 18 years or older.
Courageous/Lifesaving Award (Professional) - Nominee performed an extraordinary courageous and/or lifesaving act or an act having community impact. Nominee must be a public servant (i.e. fire, police, medical, military, etc.) and the act may have occurred on or off duty.
Courageous/Lifesaving Award (Business/Industry) - Nominee is associated with a rescue or other act of extraordinary kindness exhibited towards a co-worker, client, or visitor while on the job and/or on workplace property.
Extraordinary Youth Award - Nominee is 17 years or younger and is associated with a rescue or other act of extraordinary kindness, courage, or unselfishness in a time of need.
_____________________________
Nominee Information (Note: Please fill out as completely as possible. If you do not have contact information, we
would appreciate any leads you can provide on how to contact this person.)
Name _________________________________________________________________________________________________
Age (if under 18) ________________________________________________________________________________________
Business or organization (if applicable) _______________________________________________________________________
Address _______________________________________________________________________________________________
City State Zip ______________________________
Phone (Day) (Evening) (Other) __________________________
Fax Email _________________________________________________________
Leads to contact this person if above information is not available __________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
Date and location of heroic act:______________________________________________________________________________
Please describe clearly, and in as much detail as possible, the incident that occurred, and why you would like to see this
person (or group of people) honored for their heroic act. Feel fee to attach any supporting information.
All statements will be reviewed by a Community HEROES selection committee. Each nominee will be notified to verify
facts surrounding the event. Please tell us if you wish to remain anonymous.
Event details:
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
Date submitted: ________________________________
For information, or to learn more about the March 20, 2010 Community HEROES Breakfast event, please call
440-998-1020. Please mail nomination forms to:
Community HEROES
Ashtabula Chapter American Red Cross
433 Center Street, Ashtabula, Ohio 44004
Nomination forms may be faxed to: 440-998-2995
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