2023 TASA Individual Award Nomination

DEADLINE FOR NOMINATIONS = December 15, 2022

2023 TASA Individual Award Nomination

PDF for Award Nomination Description

Your Name*

Your Email Address*

Your Phone #*

Your relation to the Nominee*

Award Title*

Select the award that you are nominating forEMT of the YearParamedic of the YearAdministrator of the YearMedical Director of the YearEMS Advocate of the YearLifetime Achievement

Nominee's Name*

Nominee's Street Address*

Nominee's City*

Nominee's State*

Nominee's Zip Code*

Provide a supporting narrative (reason for the nomination)*

Upload File (1) (Supporting documents i.e. articles, letters of support, photos, etc.)

Upload File (2)

Upload File (3)

Upload File (4)

Upload File (5)

Please enter the letters/numbers in the box

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