Hematology Oncology
HERO CAMPAIGN
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2008 VIDACARE® HEROES ENTRY FORM

Entry Rules:

  • Heroes will be nominated and selected on a monthly basis
  • A person cannot nominate his or her self
  • The winning entry must be based on the use of the EZ-IO® to gain vascular access
  • The nominee must have been employed with an emergency service or hospital at the time of the event
  • The nominee must be currently employed with an emergency service or hospital
  • Winner’s must agree to have their story used in Vidacare promotional materials

*All Fields Required for Campaign Entry
Your Name:
  
Your Email:
Telephone Number:
Name of Person you are Nominating:
Relationship to the Person you are Nominating:
Nominee's Phone:
Nominee's Email:
Nominee's Employer:
City:
State/Province:
Country:
The Story:

Please omit any patient identifiers from the entry.

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