Wisconsin Child Passenger Safety Hero Nomination Form
Wisconsin Child Passenger Safety Heroes is your opportunity to recognize an exceptional individual or group who have contributed to the field of Child Passenger Safety in Wisconsin.

Heroes do not have to attend the Governor’s Conference to be nominated and they do not have to be a CPST. All nominees will be recognized in a presentation during the Wisconsin Governor’s Conference.

Nominate your heroes by August 1st, 2019.

Nominator Information
First Name:
Last Name:
Email Address:
Hero Information
Name of Individual or Group:
Email Address:
City:
State:
Zip Code:
Hero's Affiliation: Please provide us with the name of the organization they work or volunteer for.
My nominee is a hero because:
Please upload a photo of the hero
Submit
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