Name of Nominee/Organization
(for organization, please include a contact person): | |
| Nominee/Organization Phone: | |
| Nominee/Organization Email: | |
Organization in which the nominee is active and
description of volunteer work: | |
| Description of Organization and its Activities: | |
| Nominator's Name: | |
| Nominator's Phone: | |
| Nominator's Email: | |
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