Heartsaver Hero

The American Heart Association works to save lives by encouraging CPR & AED training. Are you a survivor who wants to recognize the person who performed CPR to save your life? Are you a rescuer or someone who knows about a rescue event? We want to recognize those heroes who used their skills to save a life.

Please fill out this form so that the rescuer can be recognized and the AHA can keep a record of survivor stories and CPR use. Allow 7–10 working days for turnaround. In some cases, awards can be fulfilled more quickly. Please contact survivorstory@heart.org with questions or rush requests.

STEP 1: Survivor Information

Survivor Name:*
Survivor Occupation:
Gender:*
 Male Female
Age at time of incident:
Ethnicity:
African American
Asian
Caucasian		 Hispanic
Native American
Other
   
Type of Incident:*
Sudden Cardiac Arrest
Drowning		 Stroke
Other
   

Location:
Home
School		 Work
Other
   
Survivor contact information. We can not ship to a PO Box.*
Street:*
Apt.:
City:*
State:*
Zip:*
Phone:*
E-Mail:*
Brief description of event:*
Do you currently work with someone at the AHA? If so, please tell us who:
   
STEP 2: Rescuer Information

Rescuer Name:*
Rescuer Occupation:
Gender:*
 Male Female
Age at time of incident:
Ethnicity:
African American
Asian
Caucasian		 Hispanic
Native American
Other
   
Type of Incident:*
Sudden Cardiac Arrest
Drowning		 Stroke
Other
   

Location:
Home
School		 Work
Other
   
Rescuer contact information. We can not ship to a PO Box.*
Street:*
Apt.:
City:*
State:*
Zip:*
Phone:*
E-Mail:*
Brief description of event:*
Address where you would like the Heartsaver Hero award mailed:*
Street*
Apt.
City*
State*
Zip*
   

* Fields are required.

 

Reviewed/Updated: 09/23/2009
Print   Email


Privacy Policy | Copyright | Ethics Policy | Conflict of Interest Policy | Linking Policy | Diversity
© 2009 American Heart Association, Inc. All rights reserved. Unauthorized use prohibited.
   BBB