OFFICIAL NOMINATION APPLICATION
~ Stars of Life 2015 ~
Nomination Period Open: June 1 to August 1, 2015
The Professional Ambulance Association of Wisconsin, in cooperation with the American
Ambulance Association, is pleased to produce the Stars of Life Recognition Program.
Dear Wisconsin Ambulance Service Directors and EMS Professionals and Volunteers:
Please take this opportunity to reward and celebrate an employee, volunteer, or community
citizen who exemplifies the everyday spirit and commitment of a Star of Life.
Each person nominated is presented with Wisconsin Star of Life honors! You do not need
to be a member of PAAW to submit a nomination application. All nominations are welcome.
One person from the group of 2015 honorees will be selected and advance to represent
Wisconsin at the national Stars of Life event held in Washington, D.C., April 11 to 13, 2016.
PAAW will provide a $750 travel voucher, and the American Ambulance Association Foundation
grant for hotel costs (2 rooms) and National Stars of Life event registration fees for the Star,
Stars’ guest, host (employer).
Wisconsin’s Stars will be provided special recognition at a series of three planned events.
2015 Schedule of Events
Wednesday, September 23, 2015
A late afternoon Welcome Reception and Brief Program
Green Bay Packers’ Lambeau Field Atrium, Green Bay
Opening remarks by Green Bay Packers CEO Mark Murphy*
*Participation planned, but subject to change.
Thursday, September 24, 2015
One day attendance at Paramedic Systems of Wisconsin Conference
An evening Awards and Recognition Dinner Program
Tundra Lodge and Conference Center, Green Bay
October or November 2015
One day recognition before the Senate and Assembly and
individual meetings at the State Capitol, Madison
The Stars of Life Award is an outstanding recruitment and retention tool! Many ambulance
services face challenges recruiting and retaining valuable employees and volunteers. The Stars
of Life program can be a valuable component of your organization’s efforts to recognize and
reward your staff. We hope that you will consider recognizing one or more of your staff by
registering them for the event. Equally important, we hope you will attend as their host.
The Professional Ambulance Association of Wisconsin has proudly produced the Wisconsin
Stars of Life program since 2006. It is modeled after the American Ambulance Association’s
National Stars of Life program.
Event Goals
 Reward and congratulate outstanding individuals
 Educate members of the Wisconsin Legislature regarding ambulance issues
 Project a positive image of Wisconsin ambulance services
 Generate positive local media stories regarding ambulance services and their Stars
Suggested Candidates
 Employee of the year
 On-duty or off-duty service above the call of duty
 Setting significant records
 Significant community contributions outside of EMS
 Significant community recognition or honors related to ambulance, public safety, public
health or health care services
 Local leadership in developing community partnerships that enhance EMS
Benefits to Your Organization
 The Stars are more politically aware and involved in community activities
 Legislators understand the need of ambulance services
 The public is more informed about quality ambulance services
 Local media is more aware and educated about the needs of ambulance services
Reward and Congratulate
 Reward and congratulate outstanding ambulance service employees. Let people know
that you are proud of the work they do and how hard they work to support the high
standards set by your company or organization.
Educate
 Increase visibility of ambulance professionals with members of state and local
government, community leaders, industry professionals and peers.
 Spend a day at the state capitol in Madison. Sit down with state legislators face-to-face
educating them and their staff regarding the key role of ambulance professionals and
your work as an EMS professional.
Enhance
 The image of the members of the ambulance industry and PAAW are enhanced by
generating positive media coverage statewide as well as in your local community.
Nominate
To nominate someone deserving of this high honor just download the registration packet at
http://www.paaw.us/stars-of-life. Each person nominated is presented Wisconsin Stars of Life
honors. The nomination application period is open June 1 to August 1, 2015.
Have a question about Stars of Life 2015? Email PAAW at admin@paaw.us.
The Stars of Life program is designed to recognize Wisconsin’s best-of-the-best for their
professionalism and dedication - people that stand out in every area of our field. Best of all, you
choose your "Star." Now it is up to you – nominate someone today!.
Thank you for your consideration. Again, the nomination deadline is August 1, 2015.
Sincerely,
Patrick Ryan
Patrick Ryan
President
Professional Ambulance Association of Wisconsin
Event Produced By
Gold Level Sponsor
Silver Level Sponsor
Bronze Level Sponsor
In-kind Support
Green Bay Packers
Organization
Registration Nomination Form
2015 Wisconsin Stars of Life Program
Registration Deadline: August 1, 2015
(Type data into each field, press tab to move cursor to next field. Save the document
when completed.)
Star of Life Nominee (name):
Address:
Address 2:
City:
State:
Zip:
Phone:
E-mail:
Star of Life Nominee State of Wisconsin EMT License Number (if applicable):
Star of Life Nominee State of Wisconsin Level of License (if applicable):
Stars Nominee elected state government leaders (for appointment purposes):
(Search option http://maps.legis.wisconsin.gov/?single=y)
Senator (insert name)
Assembly Representative (insert name)
Host EMS Service:
Host Contact Name:
Host Contact Job Title:
Address:
Address 2:
City:
State:
Zip:
Phone:
Host Contact E-mail:
If different than host contact, name of person completing nomination:
Schedule of Events
1- Wednesday, September 23, 2015 from 4:00 to 6:00 p.m.
Green Bay Packers’ Lambeau Field Atrium
1265 Lombardi Ave., Green Bay
Number attending the Welcome Reception with this Star:
(There is no admission fee to attend for Star honoree, Stars’ host and Stars’ guests)
2 - Thursday, September 24, 2015 from 9:00 a.m. to 8:00 p.m.
Tundra Lodge Resort and Conference Center
865 Lombardi Ave., Green Bay


Paramedic Systems of Wisconsin Conference, 9:00 a.m. to 5:00 p.m.*
Stars of Life Banquet Dinner and Awards Program, 6:00 to 8:00 p.m.
*The Stars honoree will automatically be registered to attend the Thursday Paramedic Systems of
Wisconsin Conference. Breakfast, lunch and dinner banquet is included in the registration fee.
Number attending the Banquet Dinner and Awards Program with this Star:
Itemized Host Fees – Wisconsin Stars of Life
Stars of Life Nominee’s Name
Star Registration Fee*
$150 per Star honoree
Wednesday PSOW Sessions – add $65
Friday PSOW Sessions – add $35
$150
$
$
Host Registration Fee
$35 (Dinner banquet only)
$
Stars’ Spouse/Guest
$35 (Dinner banquet only)
$
Additional Guest(s)
$35 per person (Dinner banquet only)
Total number of guests:
$
Total Due**
$
*Stars registration fee includes all official events, awards certificate, lapel pin, recognition
medallion,2015 Stars photo directory, banquet dinner ($35), and registration to attend PSOW’s
Thursday all-day session ($90).
Email the completed nomination packet to admin@paaw.us
no later than August 1, 2015.
**Upon receipt an invoice will be created and emailed to the
host agency contact person for payment within 30 days.
Biography Form
2015 Wisconsin Stars of Life Program


Please complete one form PER STAR.
Please email or mail a recent color photograph, headshot only. Email photo
to admin@paaw.us, or write the name on the back of the photo and mail with
your payment to: PAAW, Attn: Tom Tornstrom, 235 Causeway Blvd., La Crosse,
WI 54603. Handle photos carefully, do not staple, bend or paper clip.
Star of Life Nominee’s Name to be written exactly as *
Star of Life Nominee’s company name to be written exactly as *
Star of Life Nominee’s city to be written exactly as *
*Please note in this space exactly how you would like the Star’s name, company and
city to appear. This information will be used for their name badge, Stars Certificate
signed by the Governor, all award event materials, publicity, and 2015 Stars photo
album.
Biography: Using the categories below, please tell us about your Star by summarizing
the reasons this individual is being honored:

Describe the reason this person is being honored (20 words or less)

Describe a distinguishing personal trait (20 words or less)

Describe work experience (20 words or less)

Describe notable personal interests (20 words or less)

Please describe an event or experience that exhibits this individual’s commitment
or exemplary courage during service (100 words or less)
Hotel Information
Hotel Reservation Deadline for Discounted rate: SEPTEMBER 7, 2015
The Professional Ambulance Association of Wisconsin has negotiated special rates for
the Stars of Life program with the Tundra Lodge Resort, Water Park & Conference
Center.
We have a block of rooms set aside for the event on September 23 and 24. To make
reservations, contact the HOTEL directly at the number below and reference the group
name “PAAW-Professional Ambulance Association of Wisconsin”. The PAAW room
rate is $70 per night + tax, plus $10 additional per adult. Room rate includes four water
park passes.
The discounted hotel room rate ends September 7, 2015.
http://www.tundralodge.com
Tundra Lodge Resort
865 Lombardi Avenue
Green Bay, WI 54304
1-877-886-3725 or 920-405-8700
162 North woods-style suites ● Three story indoor and outdoor water park ●
Complimentary wireless Internet service ● Fitness center ● Business Center● Fullservice restaurant ● Room service