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Trailblazer Nomination Submission Form

Basic Information

Trailblazer Story:

Media and Socials:

Nomination Section (if submitting for someone else)

Sponsor/Recognition Information:

Consent and Submission:

I Give Consent
Confirm permission to share their story, photo, and media
Would you like to nominate this person for a Trailblazer of the Year Award?
Yes
No

Additional Notes (Optional):

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