Please complete the following form to submit your nomination to be a Panthers Local Hero.

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* 1. Your name:

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* 2. Your contact number:

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* 3. Your email address:

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* 4. Nominees name:

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* 5. Nominees contact number:

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* 6. Explain why you are nominating the individual?

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* 7. Which category does your nominee contribute their time to?

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* 8. Is the nominee a Panthers fan?

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