Turtle Club Registration

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Nomination proposer:

Name*

Email Address*

Phone Number*

Relation to the Nominiee:*

Nominee:

Name*

Company Name*

Email*

Street Address

City

State

Zip Code

Accident Details

Please provide your best description of what happened in the incident and how a Bullard hard hat or safety helmet helped protect the wearer’s head/face.*

Type of hard hat or safety helmet:

Year hard hat or safety helmet was manufactured:

If you have any photos or other supporting documents you wish to include, you may upload them here.

Drop files here or

Max. file size: 2 MB.

Additional Comments

Certify

I certify the statements provided above are true to the best of my knowledge. Bullard may reach out to get more information or additional details.

Certify

If Nominee is completing the nomination, I give Bullard the right to use my name, description of incident, and any photos provided on social media, the website and in printed materials.

Bullard would like to send the Nominee a New Limited Edition Turtle Club hard hat and Turtle Club member challenge coin. Please select one:

Vector/Type II hard hat (with the Turtle Club member logo).

AboveView Elevate hard hat (with the Turtle Club member logo)

Cen10 Safety Helmet

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Bullard Turtle Club Members

Turtle Club Registration

Nomination proposer:

Nominee:

Accident Details