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* 1. Your name

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* 2. Your email address

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* 3. Nominee's name

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* 4. Nominee's social media/handle profile

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* 5. Additional social media handle/profile

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* 6. Additional social media handle/profile

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* 7. Additional social media handle/profile

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* 8. Any supporting detail that you would like to add as to why you have nominated this person:

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* 9. Please confirm that the nominated person:

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