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Full Name of Person Submitting Nomination:
Full Address:
Telephone: (please use xxx-xxx-xxxx format)
Email Address:
FOUNDERS AWARD - $500 Cash Award and plaque is presented to the individual, group or organization who exemplifies the best we can be or do in sports medicine.
Nominee Name :
Full Address of Nominee::
Nominee Phone:
Nominee Email Address:
Please provide a brief paragraph on why this person should receive the AMSSM Founders Award and submit it to the AMSSM National Office by January 5, 2009.
Please enter the Email Address from where you are submitting this form:
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