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REGIONAL IMPACT AWARD NOMINATION FORM
Deadline March 2, 2026
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Candidate’s Name
Your answer
Organization (if relevant)
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Email
Your email address
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Phone
Your phone number
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Please describe the nominee’s achievements and impact in native plant conservation, horticulture, or education in New England.
350 words maximum
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Please include any supporting materials such a list of publications, current projects and/or links to other supporting documentation.
350 words maximum
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