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Awards Nomination Form
Please select the Awerd for which the candidate is being nominated (*)













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Nominees Name (*)

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Nominees Address (*)

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Nominees Daytime Phone Number (*)

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Email Address (*)

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Briefly describe what qualifies the candidate for the award (*)

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Your Name (*)

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Your Phone Number (*)

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Your Email Address (*)

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Attached the Nominees CV or Resume (*)

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Verification Code
Verification Code

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