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JAN/16/2915/FRI a2:26 PM

PAX

No,

P.

ü62

0

Betsy M.

Cowles Leadership Award

Official Nomination Form

Deadline: February 25,2015

Please type or print legibly

Name:

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BASA Member?

1Yes

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Years of continuous service

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Other positions held during the past five years:

Position

Organization

Dates

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Description of significant contributions/exemplary leadership:

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