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GUBA 2012 Nomination Form

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* 1. Name of nominator (your name)

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* 2. Your contact details:

Telephone number

Email Address

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* 3. Name of Nominee

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* 4. Nominees contact details

Telephone number

Email address

Why have you put forward this individual/service/business for a GUBA 2012 Award

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* 5. How do you think this individual/service /business has contributed to the Ghanaian community