Nomination Form

1.What is your information?(Required.)
2.I am nominating:(Required.)
3.Who would you like to nominate?
4.How many members are in the nominees immediate family?
5.Do you wish to remain anonymous if you or the family you nominated is selected?(Required.)
6.Please explain the family or individual's circumstances(Required.)
7.Why do you feel that you or this family in particular deserves to be selected?(Required.)
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