LA 43 Candidate Nomination

Please complete this form to nominate individuals for LA 43. You may nominate up to five people with this form. Thank you!

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* 1. Your name

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* 2. Your email address

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* 3. Your LA class number

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* 4. Can we use your name when communicating with your nominee(s)?

Yes

No

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* 5. Nominee one

Name of nominee

Their email address

Their employer

Why are you nominating this person for LA?

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* 6. Nominee two

Name of nominee

Their email address

Their employer

Why are you nominating this person for LA?

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* 7. Nominee three

Name of nominee

Their email address

Their employer

Why are you nominating this person for LA?

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* 8. Nominee four

Name of nominee

Their email address

Their employer

Why are you nominating this person for LA?

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* 9. Nominee five

Name of nominee

Their email address

Their employer

Why are you nominating this person for LA?