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ALATA Awards & Honors Nomination Form

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I wish to nominate the person listed below for the following award:

Note you must be an NATA or ALATA only member to submit a nomination.

 

Nominee Last Name  
Nominee First Name  
 Nominee Middle Name  
Nominee Place of Employment  
Nominee Mailing Address  
Nominee City  
Nominee State  
Nominee Zip Code  

Please try to include all numbers as requested below, but if unknown, place 10 zeros in the cell.

Nominee Work Phone  
Nominee Cell Phone  
Nominee Email  
Nominee Home Phone  
Date  
I feel this person is deserving of this award for the following reasons:

 

To the best of my knowledge, this person is a member of the Alabama Athletic Trainers Association. (not required for Sports Medicine Person of the Year Award or Sponsors Award)
Please contact me for more information about this candidate:
My name:  
My Place of Employment:  
My office number:  
My cell number:  
My home number:  
The best time to call is: A.M. P.M.
My e-mail address:  
Please enter your member number:  

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