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NOMINATION FORM

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* 1. Name and Surname

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* 2. Company

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* 3. Designation

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* 4. Industry sector

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* 5. Telephone

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* 6. Cell

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* 7. Number of years in the industry

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* 8. Nominee

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* 9. Designation of the nominee

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* 10. Company

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* 11. Industry sector

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* 12. Telephone number

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* 13. Cell

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* 14. Please explain why you believe this person should be considered for this nomination.

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