Nominate

The senior who inspires me is:

Name:

Age:

Address:

City:

State:

Postal Code:

Email Address:

Telephone:

How has this person most inspired you about aging and living well? (150 words or more) You may want to address such areas as mentoring, community involvement, exercise, nutrition, relationships, creative activities, etc. Specify what it is about your nominee that you most want to emulate for your own life.

Attach a photo of the nominee:

Tell us about yourself:

Name:

Age:

Address:

City:

State:

Email:

Postal Code:

Phone:

Nominate Someone Today

Tell us how your mentor, older friend or family member has inspired you to age well. Use our online form to nominate a senior.

You can also download and print our PDF form and mail it in to:
Inspire Positive Aging Award
2208 2nd Avenue
Seattle, WA 98121
Download the form

NOMINATION DEADLINE IS APRIL 9, 2012

If you have any questions regarding this contest, please contact Donna Bellinger at (206) 727-6267.

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Inspire Positive Aging is part of Senior Services
2208 Second Avenue, Suite 100, Seattle, WA, 98121-2055
Phone: (206) 448-5757 | Fax: (206) 448-5766 | info@seniorservices.org