Nominee Information

First Name*

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Last Name*

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Organization

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Address 1*

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Address 2

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City*

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State*

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Zip*

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Phone*

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Email*

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Nominator Information

First Name*

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Last Name*

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Organization

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Address1*

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Address 2

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City*

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State*

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Zip*

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Phone Number*

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Email*

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Why should your nominee win the Likens Award?

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What impact has your nominee had on their credit union and/or the credit union industry?

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