Step 1. Please select the type of helicopter operation involved in which your nominees were involved: *

Public Service - Any helicopter operated by a local, state or federal governmental agency other than a branch of the military.

Military - Any rotorcraft operated by any branch of the military, including Coast Guard, National Guard, Army, Navy, Air Force or Marines.

Commercial/Corporate/Private - Any aircraft not covered specifically above.

Step 2. Nominee Contact Details

Please be as specific as possible as to the exact unit, base and/or location of the crew involved in this event

Nominee's Company/Organization *
Nominee's Address *
City *
State/Province *
Zip/Postal Code *
Country *
Phone *
Extension
Fax
Email *

Please list the contact information for each of the pilots and members of the nominated crew.

Step 3. Please tell us more about the act of heroism.

Date of heroic action *
Place *

Description of scene and action taken: *

Supporting Materials

After you have submitted this form, you will receive an e-mail with the address of an FTP server. If you wish, you can upload photos and/or video. Supplementary files can be submitted in any of the following file formats:

• .avi - Audio-Visual Interleaved (AVI)
• .bmp - Windows Bitmap (BMP)
• .flv, .swf - Flash Video, Adobe Flash
• .gif - Graphics Interchange Format (GIF)
• .jpg, .jpeg - Joint Photographic Experts Group (JPEG)
• .mov - Apple QuickTime Movie (MOV)
• .mpg, .mpeg - Motion Picture Experts Group (MPEG)
• .png - Portable Network Graphics (PNG)
• .psd - Adobe Photoshop (PSD)
• www.youtube.com - YouTube URLs

Step 4. Nominator Details

Name of the person making the nomination *
Rank/Title *
Company/Organization *
Address *
City *
State/Province *
Zip/Postal Code *
Country *
Phone *
Extension
Fax
Email *
Please copy the characters from the image into this box.