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* 1. Your name

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* 2. Your phone number

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* 3. Your email address

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* 4. Hero nominee's name

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* 5. Hero nominee's phone number

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* 6. Hero nominee's email (if known)

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* 7. Hero nominee's home address (street address, city, state)

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* 8. Please describe why this individual is a hero and deserves to be honored. Tell us your story!

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