Rural Water Awards Nominations

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1. Contact Information for person making nomination: (Required.)

Name: *

Company:

Email Address:

Phone Number:

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2. Which award is this nomination for? (Required.)

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3. Nominee's Name: (Required.)

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4. Nominee's Job Title:

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5. Nominee is employed by:

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6. How long has the nominee been with the company?

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7. What are the responsibilities of the nominee in his/her current position?