OEMTA Awards Nomination Form

Please provide as much information as possible about the person you are nominating.  These nominations will be voted on by the current OEMTA Board and presented at the Annual Awards Banquet held during Medic Update each year.  If you are nominating an EMS or First Response Agency you can put the Service Director / Chiefs name as a point of contact.

First Name:       MI:      Last Name: 

Agency Name: 

Contact Phone Number: 

Award Being Nominated For:  Select OneFirst Responder of the YearEMT of the YearAdvanced EMT of the YearFirst Response Agency of the YearBasic Service of the YearAdvanced Service of the YearInstructor of the YearCommunications Specialist of the YearAdministrator

Name of Person Making Nomination:

Phone Number of Person Making Nomination:

Please include a short paragraph about this service or individual to explain your nomination.