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David H. White Memorial Award Nomination Form

Nominee Last Name
Nominee First Name
Nominee Middle Initial
Nominee Home Phone
Nominee Work Phone
Nominee Email Address
Nominee's past and present
community involvement
Please describe how the nominee
meets the selection criteria.
Nominator Last Name
Nominator First Name
Nominator Middle Initial
Nominator Home Phone
Nominator Work Phone
Nominator Email Address
Checking this box represents
your electronic signature.