2026 Fire Prevention Breakfast: Legacy Award form

Firefighter being recognized: *

Department Affiliation: *

Department Address, City & Zip: *

Department Phone: *

Department Email: *

Your Name: *

Your phone (if different than Department's):

Your email (if different than Department's):

Brief Description of Nominee: *

Include a description of why the individual was selected (indicate whether the person received a department or other award i.e. Firefighter of the Year. Share specific stories and encounters.