Thank you for taking the time to submit this form. The deadline to submit is December 7, 2025, at 11:59 p.m. PST.

Your Name *

Your Email *

Name of Person You Are Nominating (Nominee) *

Nominee's Instagram link *

What is the condition that they need help with? *

Tell us why they deserve to win this. What kind of impact do they make? (3-5 sentences) *

Does the Nominee have any pre-existing medical conditions (e.g., cancer, tumors) *

Is the Nominee on any prescription medications? (This is important; we need accurate information on this) *

Is the Nominee open to peptide therapy? *

Are you and the Nominee following @paulbakhtiar on Instagram? https://www.instagram.com/paulbakhtiar (required for consideration) *

By checking this box, I confirm that I have read and agree to the Giving Tuesday Giveaway Terms & Conditions. I understand that submitting this form does not guarantee selection and that all nominations will be reviewed according to the criteria listed in the T&C. I consent to being contacted regarding my nomination and, if selected, to provide any additional information required. I also agree that Helios may use anonymized nomination details for promotional or reporting purposes as outlined in the Terms & Conditions.