Warrior Troop Nomination

To nominate someone to receive a NillyNoggin EEG Cap we just need to collect a few pieces of information from you. Please answer every question! Your answers help us fulfill your nomination! Questions? Check our F.A.Q. page for the answers!

First, Tell us About Your Amazing Warrior!

What is the name of your nominee, aka your Warrior? *

First

Last

What is their primary diagnosis? *

When is their birth date? *

Please share a bit about your Warriors journey and how amazing they are. *

What Hospital or EEG Company do you typically get your EEG? *

What is your Warrior’s address? *

Address Line 1

Address Line 2

City

State

Zip Code

This program is currently available to residents of the United States and Canada. We do have plans to make it available to more countries in the future!

We will send you an email that will include a few pictures of NillyNoggin EEG Caps to choose from!

Please make sure the email address you entered is accurate so that we can reach you. Sometimes our emails go to spam … so be sure to check that folder if you do not see an email from us in your inbox. We will email you but if we are do not receive a response, no worries, we will send your Warrior an awesome NillyNoggin no matter what! An email with options will be sent within approximately 2 weeks from joining the Troop.

Now it’s your turn!

Your Name *

First

Last

Your Email Address *

Your Phone Number *

Are you the legal parent or guardian of your nominee? *

Is there a blog or social media page that shares your nominee’s story? *

Do you have a photo of your nominee that you would like to share? *

Name

All fields are required.

Read our Privacy Policy for details on the information we collect and how we use it.

NillyNoggin EEG Cap Nomination Form!

First, Tell us About Your Amazing Warrior!

We will send you an email that will include a few pictures of NillyNoggin EEG Caps to choose from!

Now it’s your turn!