* indicates required fields

*YOUR NAME:		GENDER:FemaleMale
AGENCY/ORGANIZATION:
OTHER AFFILIATIONS (such as other organizations, churches, schools, etc.):
*ADDRESS:
*CITY:	*STATE: Select One Alabama Alberta Alaska Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northwest Territories Nova Scotia Nunuvat Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Yukon Other	*ZIP:
PHONE:	FAX:
*Email:	*Date of Birth: Month January February March April May June July August September October November December Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
ABOUT THE HERO
*NAME OF NOMINEE:		GENDER:FemaleMale
AGENCY/ORGANIZATION:
OTHER AFFILIATIONS (such as other organizations, churches, schools, etc.):
*ADDRESS:
*CITY:	*STATE: Select One Alabama Alberta Alaska Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northwest Territories Nova Scotia Nunuvat Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Yukon Other	*ZIP:
*Date of Birth: Month January February March April May June July August September October November December Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
STATEMENT OF SUPPORT: Our players are not only heroes on the court but also in their community. Please tell us why you are nominating this hero and what this hero has done to change or inspire others in the community like our WNBA players. Questions to think about: How has your hero has touched your life? How has this hero changed your life or inspired you to achieve when you thought you could not, just like the WNBA players?
ESSAY: (500 word max):
I would like to nominate this person as a Local Hero in the select cities: Houston, Indiana, Sacramento, San Antonio and Seattle to participate in a pre - game reception, receive tickets to the game and have a $1,000 donation made to a charitable organization of hero’s choice.
Local Contest Rules/Prizes