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Fearless Americans Candidate Submission Form:

Your Name:
Your email address:

Name of Candidate:
Date of Birth:
Place of Birth:
Category:
Media Upload: (Please upload an image or video.
Statement Upload: (Please upload a written statement of award winner)
Description of Fearless act.:
Waiver & Release:
I, (print name) , by executing this release, do herby for myself, heirs, executors, administrators, agents and assigns, waive any rights to any compensation whatsoever for the use of pictures or video production, of my image or likeness, utilized by those associated with this website (FearlessAmericans.com) for any profit making motives, at anytime. I understand that it is up to the sole discretion of the owner and managers of FearlessAmericans.com to determine if, when and how to compensate me for the use of any pictures, videos, stories, or images submitted by me. Click here to approve

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