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* 1. Your Contact Name

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* 2. Your Company Name

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* 3. Your Contact Telephone

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* 4. Company Address

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* 5. Email Address

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* 6. I am submitting an entry for the following award:

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* 7. Name of product / nominee

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* 8. Nominee Company Name

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* 9. Nominee Email Address

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* 10. Statement of nomination

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* 11. The nominee has confirmed availability to attend the ceremony

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