Nomination Form
If you would like to nominate yourself or someone else to receive support from #LOVEWINS, please complete and submit this form. We will take all nominations into careful consideration and will reach out with any questions. Thank you so much!
First Name
Your answer
Last Name
Your answer
Mailing Address
Your answer
Phone Number
Your answer
Email
Your answer
Were you at Route 91 2017?
Name of Person You Would Like To Nominate (if not you)
Your answer
How Can We Help? (please provide a short description of what type of help/assistance you are requesting)
Your answer
Submit
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