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* 1. What is your first & last name?

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* 2. What is your phone number & email address?

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* 3. Who is the nominee?

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* 4. Where does the nominee live? (City & County)

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* 5. What is the nominee's job & industry?

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* 6. What is a unique aspect of the nominee's career/story? (Min 75 Words)

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