Nominee First Name*

Nominee Last Name*

Nominee's Title and Place of Employment*

Nominee Cell Phone Number*

Nominee Email*

Describe the nominee’s job responsibilities.

Tell us about a current project the nominee is working on and how it will benefit the community.

Describe the nominee’s community involvement.

What impact has the nominee made on 417-land?

What makes the nominee stand out from their peers?

What else can you tell us about the nominee that will help us make our decision?

Your First name*

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Your Email*

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