MOTHERS AGAINST DRUNK DRIVING ‘ TAKE THE WHEEL ’ 2023 RECOGNITION AWARDS LEADERSHIP HERO NOMINATION FORM (PLEASE TYPE)
Leadership Hero - Given to chiefs/commanders/captains/supervisors who have shown superior commitment to DWI enforcement by providing their departments and agencies with the resources, support, and trainings needed to reduce drunk and drugged driving.
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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