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Nomination Form - BIANYS Board of Directors
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Email
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Your email
Submitted by
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Nominee First Name
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Your answer
Nominee Last Name
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Your answer
Incubator/Organization
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Your answer
Member Type
*
Supporting Member
General Member
Other:
Nominee's Email
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Your answer
Phone Number
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Your answer
Mailing Address 1
Your answer
Mailing Address 2
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City
*
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State
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Zip
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Previous Experience with BIANYS
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Statement on why nominating committee should consider the nominee
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Affiliations or organizations nominee belongs to:
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