AMAC CONVENTION REGISTRATION SCHOLARSHIP - NOMINEE FORM

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* 1. Name & Community Bank (or Associate Member Company) of Person Nominating:

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* 2. Nominee Name:

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* 3. Nominee Title:

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* 4. Nominee Community Bank:

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* 5. Why is this nominee deserving of the AMAC Convention Registration Scholarship? (Please share a few sentences about why this opportunity would benefit them and their community bank.)