NOMINATON FORM Nominate a friend or family member for an outdoor experience of a lifetime! Your Name * First Name Last Name Phone * (###) ### #### Email * Relation to Nominee Nominee Name First Name Last Name Nominee Age Guardian of Nominee (if not you) First Name Last Name Guardian Contact Information (phone, email, address, city, state) Guardians of Nominees must be informed and in agreement with this nomination The guardian has been informed I have yet to inform the guardian Nominee experience in the outdoors Nominee physical limitations Nominee emotional limitations What type of outdoor activity do you think would be best for the Nominee? Has the Nominee done this activity before? Nominee's other interests (sports, hobbies, etc.) Is the Nominee able to travel? Yes No If so, how far? Within 50 miles of home Within home state Anywhere in the US Why should the Nominee be selected for an adventure with Himmelsberg ? Income Range of Nominee’s household <$50,000 $50,001-$100,000 $100,001+ Thank you!
