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* 1. Contact Information:

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* 2. Chapter:

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* 5. BOG Chairman's Name:

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* 6. BOG Chairman's Email:

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* 7. BOG Chairman's Phone Number:

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* 8. List all activities and experiences of the Board in connection with its service to the chapter:

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* 9. Describe how the Board of Governors helps and supports the chapter:

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* 10. Please provide any additional information you would like to share with the Awards committee:

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* 11. Additional Supporting Documents or Letters of Recommendation:

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