Nominator and Seconder Information

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* 1. What is your full name?

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* 2. What is your position?

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* 3. What is your address?

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* 4. What is your phone number?

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* 5. What is your email address?

The following awards require a secondary nominator:

Early Career Researcher Award
Lifetime Achievement Award
Diabetes Educator of the Year Award

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* 6. What is the seconder's name?

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* 7. What is the seconder's position?

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* 8. What is the seconder's address?

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* 9. What is the seconder's phone number?

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* 10. What is the seconder's email address?

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