Who is submitting the nomination?

What is your name?

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* 1. What is your name?

What is your mailing address?

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* 2. What is your mailing address?

What is your email address? In case we have questions about your nomination.

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* 3. What is your email address? In case we have questions about your nomination.

What is your telephone number? (This can be home or cell number)

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* 4. What is your telephone number? (This can be home or cell number)

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