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2. Submitter Information
4. Name*
6. Phone Number*
8. Email Address*
10. Nominee Information
12. Name*
14. Phone Number*
16. Email Address*
18. Brief description of nominees’ significant contribution to the local community through volunteer service, charitable or civic contributions that enhanced community life*
20. Additional Information (if applicable)
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22. 1. Receive an email copy of this form.
23. Email address

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24. Submit

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