INSTRUCTIONS
To nominate someone for a Community Heroes Award:
1. Print this page
2. Complete the nomination form
3. Fax the form to (401) 459-1333 or mail it to:
Blue Cross & Blue Shield of Rhode Island
444 Westminster Street
Providence, RI 02903-3279
ATTN: Community Heroes Award
If you prefer, call (401) 459-1304 to nominate a Community Hero by phone or CLICK HERE to submit your nomination online.
Information about the person you are nominating:
Name: ______________________________
Address: ____________________________________________________________
Telephone (Daytime): _______________ Telephone (Evening): _______________
E-Mail: ______________________________
Employer (optional): ______________________________
Please use the space below to tell us briefly why the person that you have nominated is a community hero:
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
Information about you:
Name: ______________________________
Address: ____________________________________________________________
Telephone (Daytime): _______________ Telephone (Evening): _______________
E-Mail: ______________________________