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* 1. What is your information?

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* 2. I am nominating:

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* 3. Who would you like to nominate?

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* 4. How many members are in the nominees immediate family?

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* 5. Do you wish to remain anonymous if you or the family you nominated is selected?

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* 6. Please explain the family or individual's circumstances

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* 7. Why do you feel that you or this family in particular deserves to be selected?

0 of 7 answered
 

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