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* 1. What is your name?

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* 2. What is the name of the person you are nominating (please note UAEA will only consider nominations of current UAEA members)

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* 3. Please describe why you believe this person is "exemplary" and deserves UAEA recognition

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* 4. Is there any other information we should consider when evaluating this person?

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* 5. If you feel comfortable, please provide your email or phone number (if we need more information we may need to reach out)

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