Annual Esquao Awards Gala - Nomination Form

Name *
Prefix
First *
Last *
Suffix
Nominee Phone Number *

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Address *
Street Address *
Address Line 2
City *
State / Province / Region *
Postal / Zip Code *
Country *
First Nation #:
Inuit #:
Métis #:
I am nominating this person for the category of: *
Describe the Nominee *
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Nominator Name *
Prefix
First *
Last *
Suffix
Nominator Phone Number *
Nominator E-mail *
Address *
Street Address *
Address Line 2
City *
State / Province / Region *
Postal / Zip Code *
Country *
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