Older American's Month FREE System Sweepstakes Nominate a Special Senior today and enter to win a FREE Medical Alert System for 6 Months!* Question Title * 1. What is your name? OK Question Title * 2. What is the name of the person you are nominating? OK Question Title * 3. What is your relation to the nominee? OK Question Title * 4. How old is the nominee? 65-70 70-75 75-80 80+ OK Question Title * 5. What is the nominee’s current living situation? Lives alone Lives with a loved one Lives in assisted living Other OK Question Title * 6. Has this senior ever experienced a fall? Yes No I’m not sure OK Question Title * 7. How has this senior impacted you or his/her community? OK Question Title * 8. What is your favorite trait about your nominee? OK Question Title * 9. Is your nominee on a fixed income? Yes No I’m not sure OK Question Title * 10. What is your email address? OK Question Title * 11. What is the best number to reach you? OK DONE