Turtle Club Register

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

CAPTCHA

Bullard Turtle Club

Register

The nominee named below escaped serious injury by wearing a hard hat at the time of an accident. I hereby make an application for his/her membership to join the Turtle Club.

Nomination proposer:

Nominee:

Accident Details