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10News Leadership Nomination Form

and last updated 2021-10-14 18:46:05-04

Submission Form

Nominee Full Name

Organization Name

City

Nominee Email

Nominee Phone Number

Nominator

City of person making nomination

Phone number of person making nomination

Email of person making nomination

Contribution to the community

People served

Is nominee still involved?

Volunteer or paid?

How long has the program been around?

Website

Relationship to the nominee

On-camera as part of the presentation

I'm not a robot

I'm not a robot

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