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Steel Magnolia Moms + We Choose Happy
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Your Information
First Name
Last Name
Email
Phone Number
Address
Apartment, suite, etc.
City
State
Zip/Postal Code
Recipient Information
Who are you nominating?
A Steel Magnolia Mom/Child
Myself/Child, I am a Steel Magnolia Mom
Are you a current social member of Steel Magnolia Moms?
yes
no
Person you are nominating: ( if nominating yourself, write self)
Recipient Age
Recipient or parent of recipient email address
What is the disability or special needs medical condition of the person you are nominating?
Has the recipient ever recieved a "wish" from a different organization?
Yes
No
Im not sure
If you chose yes to received a wish please give detail.
Is the recipient currently living with the disability or medical condition?
Yes
No, the recipient has recovered from the disability or medical condition
Does the recipient and/or family know you are nominating them?
Yes
No
Please tell us the story of why you are nominating this recipient?
What in your opinion would make this recipient the happiest?
Is there a specific "happy" you are requesting for this recipient?
Recipient's Favorite Things?
Is your request for a "Happy" timely? if so, please explain:
If my monimation is not selected in the month i submit it, i would like to have my application kept in the pool for consideration.
Yes
No
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