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THE MEDICO-LEGAL SOCIETY OF TORONTO AWARD
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Based on the Criteria: Provide a summary (maximum two pages in length) summarizing the reasons for the nomination
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PART I: NOMINEE DETAILS
Nominee Name:
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Address:
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City, Province
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Postal Code:
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Contact No:
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Email:
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PART II: NOMINATOR(S) DETAILS
Nominator Name:
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Address:
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City, Province
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Postal Code
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Contact No:
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Email
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Is your nominee aware of the nomination?
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