Nomination Form

Raise the Roof Nomination form

NAME*
First Last
EMAIL ADDRESS*
BEST PHONE TO CONTACT YOU*
ADDRESS OF THE ROOF REPLACEMENT*
Street Address City State Zip
SHOW US WHY YOU NEED A NEW ROOF*
Drop files here or

Accepted file types: jpg, gif, png, pdf.
Please upload up to 3 photos
TELL US WHY you (or the nominee) are the perfect candidate to receive a new roof.*
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