Award Nomination Form
Which award are you nominating this person/team for?
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PA of the Year
PA/MD Team of the Year
Distinguished Fellow of the Year
Gerald H. Ross Lifetime Achievement
Name(s) of the person(s) you are nominating
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Nominee's E-mail
Nominee's Phone
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Area Code
Phone Number
Please provide comments/reasons for your nomination.
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Your Signature
Signature
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Signature date
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Submit Nomination
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