Assets In Action Nomination Form

Your Name:*
First Last
Your Phone Number:*
Your Email Address:*
Nominee's Name:*
First Last
Nominee's Place of Employment and/or Place of Volunteer Service:*
Nominee's business or Home Mailing Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Why does the nominee deserve to be recognized as the Ray County Coalition Assets in Action Awardee?*
Name
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