In Recognition of form — California Council for Wildlife Rehabilitators

Please fill out the form and we will post it on our website. If you have any photos of the person please email them to webmaster@ccwr.org.

Person Being Nominated

First Name

Last Name

Reason for Submission

Date of retirement or passing

MM

DD

YYYY

Tell us about this person

How long was this person in the field of Wildlife Rehabilitation? What were their major accomplishments? Is there a good story about them? Please email us a picture at info@ccwr.org.

Add a link for more information

http://

Your Name

Not required but we would like to know who is submitting so that we may contact you for further information.

First Name

Last Name

Your Email