Star of Life 2019 Nomination Form



Stars of Life 2019 Nominee


Please print the Stars name exactly as it should be displayed on printed material.


(The Star’s home address is for the purpose of identifying the House and Senate members the Star is a constituent of in order to schedule legislative appointments and will not be used for any other purpose by the MAA.)



Biography:
Please tell us about your Star by summarizing the reasons this individual is being honored.