Nomination Form

If  you would like to nominate a deserving diva please send us your nomination. The Nominee should meet one of the following criteria:

Recently diagnosed, currently in treatment or less than 6 months out from the completion of  their treatment.

Please fill out the form below to nominate your deserving diva!

Your Full Name (required)

Your Email (required)

Your Contact Number (required)

Full Name of Your Nominee (required)

Diva's Email (required)

Diva's City (required)

Diva's State (required)

Diva's Contact Number (required)

A brief description of your reason for nomination (required)

 

You can also email your Nomination to adivaday@gmail.com 

All nominations must include:

Your Full Name

Contact Information

Full Name of your Nominee

Nominee’s Contact Information

A brief description of your reason for nomination

We look forward and thank you for your Nomination!

 

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