* Name of family needing assistance:

>DaElf

Nominee's address — Street:

>

Apt, Suite, Bldg. (if any):

>

City:

>North Pole

State / Province / Region:

>Ak

Country:

>USA

* Main phone number of nominee:

>1800Santa

Secondary phone number of nominee:

>

Email of nominee:

>Bernard @Santa.com

Nominee's Facebook page (full web address, starting with http://):

>

Nominee's CDL: if you have a copy and the nominee has said it's OK,

please attach a photo of it to your reply. (Write "attached" here if

you did):

>

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FAMILY INFORMATION

Number of adults 18+ (pick one: 0, 1, 2, 3, +3):9

>

Number of children 12 to 17 yrs (pick one: 0, 1, 2, 3, 4, 5, 6):9

>

Number of children 6 to 11 yrs (pick one: 0, 1, 2, 3, 4, 5, 6+):9

>

Number of children infant to 5 yrs (pick one: 0, 1, 2, 3, 4, 5, 6+):9

>

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WHY ARE YOU NOMINATING THIS TRUCKING FAMILY?

* Your relationship to the family (pick one: Spouse, Parent, Child,

  Brother/Sister, Other family member, Friend, Co-Worker, Employer,

  Organization, Other):

>

* Explain in detail why the nominee needs assistance. Please be as

  descriptive as possible — the more information we have, the better

  we will be able to help. (Write as much as you need.)

>Santa's sick and I'm struggling to make Christmas happen

>

>

Video link (not required): if you made a short video (under 5

minutes) to go with this nomination, put the link here — full web

address, starting with http://:

>

* Is the nominee a Truck Driver? (Yes or No):

>

Yes

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NOMINEE'S CONNECTION TO THE TRUCKING INDUSTRY

If the nominee is not a Truck Driver, what is their occupation?

>Sleigh driver

Current Employer:

>Santa Enterprises 

Former Employer:

>Frosty's Brothel and Emporium

* How many years in the trucking industry? (pick one: 1-5, 5-10, 10+):

>199

* Company Driver or Owner Operator? (pick one: Company Driver,

  Owner Operator, Don't Know): Company 

>

* To the best of your knowledge, has the nominee or any of their

  immediate family received assistance from Truckers Christmas Group

  in the past? (pick one: Yes, No, Unsure):

>

No

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YOUR CONTACT INFORMATION

* Your name:

>Bernard 

City:

>North Pole

State / Province / Region:

Ak

* Do you wish to remain anonymous to the family you're nominating?

  (pick one: No, Yes):

>Yes

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