Celebration of Survival Nomination Form

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Celebration of Survival Nomination Form

Please share your story (your own personal story of survival or story of someone you saved) Please do not include personal information like names or IDs:*

Are you available on the evening of November 2nd, 2017?*

Yes

Are you nominating someone other than yourself?*

Yes

Are you able to make time for a potential fitting & outfit pickup prior to the show, tentatively in October?*

Yes

Are you comfortable being photographed while walking the runway?*

Yes

Contact Information

Company:

First Name:*

Middle Name:

Last Name:*

Address:*

Address2:

City:*

State:*

Postal Code:*

Country / Location:*

At least one phone number is required.*

Mobile Phone:

Home Phone:

Email:*

South Florida Celebration of Survival Fashion Show

EVENT INFORMATION

Thursday, November 2, 2017
Welcome Hour: 6:00 - 7:00PM
Fashion Show: 7:00 - 7:30PM
After Party: 7:30 - 9:00PM

Gallery of Amazing Things
481 South Federal Highway
Dania Beach, Florida 33004

General Inquiries &
Event Sponsorship Inquiries
Tricia Hudson
tricia.hudson@heart.org
(954) 364-5005