Give the Gift of Hearing

Fraser Valley Beltone

Nominate Someone You Know
to Receive the Gift of Hearing

Fraser Valley Beltone is giving away a set of top of the line hearing aids to 3 people as part of our Gift of Hearing promotion.

Complete all sections of the form below to nominate someone to receive the Gift of Hearing. All nominations will be reviewed, and finalists will be selected based on a variety of criteria. Finalists will be notified by July 31, 2023.

All nominees need to be 19 years of age or older, a resident of British Columbia and able to attend, in person, one of the 4 Fraser Valley Beltone locations for their hearing assessment and follow up.

Nomination Form

Complete this section with your information if you’re the one doing the nominating.

First Name

Last Name

Organization

Street Address

City

Postal Code

Phone (Home)

Phone (Cell)

Relationship to the person you are nominating

Does the person know you are nominating them?

Yes No

You understand all nominees will be considered however a limited number of nominees will receive the free hearing aids and service. You also understand the decision of the review panel is impartial and final.

Yes No

I acknowledge the recipient must consent to having his/her picture and story used in future marketing.

Yes No

Complete this section with information about the person you are nominating.

First Name

Last Name

Street Address

City

Postal Code

Phone (Home)

Phone (Cell)

Is this person over 19 years of age?

Yes No

Why do you think they need hearing aids?

Why do you think they need to receive the free hearing aids? What are their circumstances that require this kind of support?

Terms and Conditions

I have read and accept the terms of conditions of eligibility as nominator. I understand any conditions that need to be met by the nominee will be reviewed with the nominee if they are selected to the short list and I have no responsibility for the nominee meeting the terms and conditions. Read Terms and Conditions

Give the Gift of Hearing

Fraser Valley Beltone

Nominate Someone You Know to Receive the Gift of Hearing

Nomination Form

Fraser Valley Beltone

Nominate Someone You Know
to Receive the Gift of Hearing