Please complete the form below accurately and ensure that you indicate the name, company, occupation and contact information of the nominee for the Buhl Regional Health Foundation's Front Line Hero Award. Nominations will be accepted on a rolling basis through June 30, 2022. There will be a weekly drawing of nominated individuals for a $25 gift certificate to a local restaurant to thank our Front Line Hero's for their service and dedication to our community. Recipient must work and/or reside in the Buhl Regional Health Foundation service area. 

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* 1. Nominated Person (First & Last Name)

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* 2. Company

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* 3. Occupation (i.e. nurse, EMS, physician, etc.)

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* 4. Email

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* 5. Phone Number

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* 6. Briefly describe why this person should be recognized for their efforts to provide exemplary care and service to the community during the COVID-19 Pandemic:

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* 7. Submitted By (First & Last Name)

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