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* Brief summary of your responsibilities:

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* Type of Organization:

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* Organization Information:

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* Have you ever served as an Examiner for the AHCA/NCAL National Quality Award?

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* If yes, please select which type of examiner:

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* Have you ever served as an Examiner for the Baldrige National Quality Award or related State level awards?

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* If yes, please select which type of award program:

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