Nominate A Black Dad for the, "Black Dad of the Month Award"

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1. Your Name

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2. Your Email

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3. Your SMS Text Number

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4. Name of the father you are nominating

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5. SMS text number of the father you are nominating

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6. Email of the father you are nominating

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7. Zip Code of the father you are nominating

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8. Do you want your nominee to know they were nominated by you?

Yes

No