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Women of IMPACT
Nomination Form
YOUR First Name
YOUR Company/Organization
NOMINEE First Name
YOUR Last Name
Email
NOMINEE Last Name
Brief Bio/Info on Nominee
Please provide your Nominee's contact info so we can reach out to her. Is there anything else that you would like to add?
May we share that you nominate this person?
Yes!
No, I'd prefer not.
Add answer here
SUBMIT NOMINATION
Thanks for submitting!
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