Star Award Nomination form


Important Note

  • A copy of the Incident Run Report MUST accompany the nomination.

  • Confidential patient information should be deleted.

  • Please e-mail run report to or mail to AMKUS Rescue Systems, Attn: Star Awards, 4201 Montdale Drive, Valparaiso, IN 46383

  • The information and/or photos relating to the incident may be used by AMKUS for instructional, promotional or marketing purposes. If for any reason you do not wish to release this information please indicate so in an e-mail to AMKUS at