BHS Survey Module

Berkshire Heroes Nomination Form

Berkshire Heroes are the people and organizations that have had a positive impact on the lives of those being treated for cancer in our community. Heroes can be:

Healthcare Providers who spend their days (and nights!) caring for the extraordinary people of the Berkshires

Patients who have helped each other get through this difficult time

Caregivers who provide incredible support for their friends and family

Members and organizations of our Compassionate Community: the people who fight to raise awareness for the cancer cause, philanthropists, researchers, or even just the folks who thought they were only making a small difference but in the eyes of the patient it was a huge positive impact.

Please make your nomination below. Nominations will be accepted until October 6, 2016.

* Indicates required information

Please provide the following information to help us best serve you.

First Name *
Last Name *
Email *
Phone *

1. *	Please put the name, address and phone number of the person you are nominating for Berkshire Heroes.
2. *	My nomination for a Berkshire Hero is:
3. *	Please tell us why you feel this individual deserves to be recognized among Berkshire Heroes.

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Programs & Services

BHS Survey Module

Berkshire Heroes Nomination Form