Nomination Form: 2019 Inspiring Mothers of Georgia
Please nominate a mother from your community who represents the characteristics of strength, kindness, caring, sacrifice and generosity. Nominations are due no later than 11:59PM EST, February 15, 2019. Late nominations will not be considered. Selected candidates will be notified in March, 2019. HMHB will honor selected awardees on April 28, 2019 at the Second Annual Mother's Day Luncheon.
Your Name *
Your answer
Your Relationship to Nominee *
Your answer
Your Address *
Your answer
Your Phone Number *
Your answer
Your E-mail Address *
Your answer
Would you be willing to be the Liaison of the Nominee if they are chosen? *
Can you ensure that the Nominee can attend the 2018 Mother's Day Luncheon on April 28th, 2019 1:00pm - 3:30pm if they are selected? *
Nominee's Full Name (First and Last) *
Your answer
Professional Title *
Example: Full-Time Mom, Accountant, Hairdresser, Consultant, Doctor, Etc.
Your answer
Where Does She Work or What is Her Organizational Affiliation? *
If none, put 'none' or N/A
Your answer
Business or Organization Address
If none, put 'none' or N/A
Your answer
Nominee's Home Address *
Your answer
Nominee's Phone Number *
Your answer
Nominee's Email Address *
Your answer
Number and Ages of Children/Grandchildren *
Your answer
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