Newspaper N.E.A.C.E. Nominating Member Name Your EMail Your Phone Date
Nominee's Name Nominee's Title Nominee's Year of Birth
Street Address Address Cont. City/Town State ZIP Nominee's Phone (w/ area code)
Describe the act of valor in DETAIL including the who, what, when, where, why, & how. Include a comment if there are any supporting materials, letters of recognition, etc.
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