Please enter your name.

Please enter your email address, so we can notify you when the nomination is posted and provide updates about the competition and winner.

What is the mother's name?

What is the mother's email, so we can contact her when nomination is posted and competition begins?

Tell us about the mother you want to recognize. (200 words max):

What is your favorite memory with this mother? (200 words max):

What is your favorite piece of advice this mother has given you? (200 words max):

Why do you think it's important to save mothers from pregnancy-related complications? (200 words max):

Why should your nominee deserve to be Saving Mothers' "Mother of the Year"? (200 words max):

Please upload 2-4 photos of the nominee.

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