Award Nomination Form

All portions of this form must be completed for the nomination to be valid. Please use one form per nomination.

These include elected or appointed positions at the national, chapter and/or district levels, and involvement in committees, task forces, etc. Please provide as much information as possible, including dates. 
How do the candidate's contributions affect eligibility for the award?  Please be specific.
Please describe activity in detail and submit materials as specified in award criteria:

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