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Community Builder Nomination

  1. Nominee Information:
    Provide the name, address and telephone numbers of the person or business you are nominating. If a business or community group, please provide a contact person.
  2. Nominator Information:
    Persons submitting nominations should include their names, addresses, and telephone numbers. Explain how you know the nominee.
  3. What makes this person a "Community Builder"?
  4. Leave This Blank:

  5. This field is not part of the form submission.