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* 1. Your name:

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* 2. Your phone number:

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* 3. Your email:

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* 4. Name of the nominee (the person you are nominating):

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* 5. The nominee's email address:

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* 6. The nominee's phone number:

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* 7. Please tick boxes that best describe the nominee's involvement in General Aviation (GA).

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* 8. Nominee's date of birth

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