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First and Last Name of Nominator:
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Nominator's District/School/Region/Association:
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Nominator's Position:
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Nominator's Email:
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Nominator's Phone Number (home/cell):
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Nominator's Phone Number (work):
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First and Last Name of Person Being Nominated:
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Your relationship with the nominee/applicant:
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Please type a statement (3,000 characters max) of nomination in the box below that includes information about the following:
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