Submission   
 
Superheroes in Scrubs Nomination Form
 

Please nominate a nurse below for the KFOR and Hunter Super Techs Superheroes in Scrubs recognition program on Oklahoma's News 4.

Hunter Super Techs is a proud sponsor of Superheroes in Scrubs on Oklahoma's News 4. 

 
Nominator's Information
 
* First Name: 
 
* Last Name: 
 
* Email: 
 
* Phone: 
 
* Address: 
 
* City: 
 
* State: 
 
* Postal Code: 
 
Superhero in Scrubs Nurse's Information
 
* Superhero in Scrubs Nurse's Photo: 
 
  Please upload a JPEG file (.jpg or .jpeg)  
 
Superhero in Scrubs Nurse's Photo 2 (optional): 
 
  Please upload a JPEG file (.jpg or .jpeg)  Please have only the athlete in the photo.
 
* Superhero in Scrubs Nurse's Name: 
 
* Superhero in Scrubs Nurse's Home Phone Number: 
 
* Superhero in Scrubs Nurse's Workplace: 
 
  Words Remaining:
 
* Tell us about your Superhero in Scrubs: 
 
* Please tell us something special about why you have nominated this person for Superheroes in Scrubs.: 
 
  Please tell us something special about why you have nominated this person for Superheroes in Scrubs.
 
Nominator Declarations
 
*   
    I am 18 years of age or older.
 
*   
    I have read and accept the Terms and Conditions for participation.
 
*   
    I have explicit consent from the photographer to use the photo within this submission.
 
Double check to make sure your entry is correct and then hit submit below.
By submitting the form you are confirming you are at least 18 years of age and have read and agreed to our terms of service, privacy policy and pet photo submission guidelines.
 
 
   Official Rules   

Nominate a Superheroes in Scrubs

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