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* 1. Name of Candidate

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* 2. Institution

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* 3. Email Address

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* 4. In what city does the nominee reside?

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* 5. In what country does the nominee currently reside?

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* 6. What is your gender?

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* 7. Position Being Sought

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* 8. Is the candidate willing to be considered for another Council position?

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* 9. Have you confirmed with the nominee that they are willing to serve on Council if elected by the membership? (If self-nominating, please check yes.)

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