McCune-Brooks Healthcare Foundation Humanitarian of the Year Award
Nominee Name: __________________________ Phone (Day): ______________(Evening): _______________
Nominee Address: _______________________________________________________________________________
PLEASE EXPLAIN HOW THE PERSON YOU HAVE NOMINATED MEETS THE FOLLOWING STANDARDS:
How does the nominee strive to improve health care in the Carthage community? ___________________________________________________________________________________________________
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Community involvement - Through promoting health care.
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Submitted by: ____________________________________ Date: _________________
Business: ____________________________________ Phone: _________________
Submit Nomination To: Humanitarian Award c/o McCune-Brooks Healthcare Foundation, P.O. Box 734 or 2427 Fairlawn Drive, Carthage, MO 64836. If you have any questions, please call Beth Simmons at 417-313-5048 or you may email completed form to: beth.simmons@mbhfoundation.com