19th Annual Ron Hering Mission Awards
Use this form to submit the 'Official' Selection for the Ron Hering Mission of Service Awards for 2017. The Ron Hering Award is given to a man or men truly living their mission in the world to have a broad impact on our society. Region / Area / Center selections are usually made from all nominated candidates within the area by a committee local men. Often, these selection committees consist of past winners of the award and Elders.
I. Award Region / Area / Center Information
Award Community Location
Area / Center Designation
What part of the Region? ie: Est Canada, NSW, Capetown, Northern California
Your answer
Is this the Official selection of the Region / Center / Area?
II. Your Information
Please provide your information so we can follow up if needed.
Your Name (first)(last) *
Your answer
Your Email *
Your answer
Your Role in the Community *
Your answer
III. Award Recipient Information
Recipient Name (first)(last) *
Your answer
Recipient Animal Name *
Your answer
Recipient Email *
Your answer
Recipient Personal Mission Statement *
Your answer
Recipient Action in the World Statement *
Please include a description of what the recipient is doing in the world. Use third person voice. 6-8 Sentences is a good length. Why are he / they doing what they do? What are he / they doing? What impact is he / they having? Who are he / they working with?
Your answer
Recipient Short Bio *
Please keep to about 50 words.
Your answer
Recipient Web Site (if applicable)
Your answer
IV. Award Mailing Information
Where should we send the award plaque when it is ready?
Award Mailing Address Name *
Your answer
Mailing Address *
Your answer
City *
Your answer
State / Province *
Your answer
Zip / Postal Code *
Your answer
Do you have a photograph of the recipient to provide? *
Link to photograph. (if available)
You can grab a link from a public website or upload an image to a service like Google drive for sharing. You may also email the photograph to communications@mkpusa.org.
Your answer
Does the ManKind Project have permission to display and promote the picture and work of the Recipient? *
Submit
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