Review of your application can take up to 1-2 weeks. If you prefer to print, fill out and email, click here to print the application form. Completed applications can be emailed to firstname.lastname@example.org
Please fill out the below application if you are nominating a loved one or yourself.
What type of experience are you looking for
Family Giveaway Option
North Conway Adventure
1 night hotel stay.
Passes to the Water Park for 2 adults and up to 3 children
$350 for Meals and travel
1 night hotel stay
Train tickets from Portland to Boston (optional)/or $100 towards gas and parking
$350 for meals
Please let us know if there is another destination you would like to visit.
Girs/Boys Trip OR Getaway with your Spouse
Girls/Boys Trip OR Getaway with your Spouse
Please Circle One
2-3 services each for 2 people
Ex: Facial & Massage plus manicure or pedicure)
Lunch or Dinner for 2
Boston Weekend Away
1 night hotel
Train tickets or $100 towards gas and parking
A Spa Service OR tickets for a show OR Sporting Event
$250 towards meals
Midcoast Weekend Away
1 night hotel
$50 towards gas and parking
A Spa Service OR Harbor Sail Cruise
6-8 friends provide a 3 course private dinner
Include 3 bottles of wine
Please be specific if this is something else you would enjoy.
Please remember to fill out all questions above and include your signature before your application can be processed and reviewed for the next step.
Thanks for submitting!