NOMINEE INFORMATION

Please input information below about the person being nominated for an award.

Question Title

* 1. I would like to nominate the following individual:

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* 2. The individual above works for the following institution:

Question Title

* 3. The individual has been a member of CUCCOA for the following number of years:

Question Title

* 4. I would like to nominate the above individual for the following award:

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