MOTHERS AGAINST DRUNK DRIVING ‘ TAKE THE WHEEL ’ 2023 RECOGNITION AWARDS UNSUNG HERO NOMINATION FORM (PLEASE TYPE)
Unsung Hero - Given to an individual or group, executive assistants/nurses/medical centers/group who go above and beyond the call of duty. This individual’s or group’s involvement must demonstrate a substantive contribution to Law Enforcement and/or DWI/DUI issues
Your Name (including rank): Your Organization: Your Street Address: Your City/State/Zip Code:
Your Daytime Phone: Your Email Address:
Nominee Name (including rank): Nominee Organization: Nominee Address: Nominee City/State/Zip Code:
Nominee Daytime Phone: Nominee Email Address:
REASON FOR NOMINATION:
Completed nomination forms must be emailed NO LATER THAN – April 3, 2023, to: Emma Dugas – State Program Manager, MADD North Texas emma.dugas@madd.org
Please call 214.637.0372 x 4828 if you have questions.
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