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Submitter Name
Nominee Name
Company —Please choose an option—A Small MiracleAymira Healthcare TechnologiesAymira
Location/Cost Center —Please choose an option—AshevilleAveryBooneBrevardBurgessBurkeCharlotteForest CityFranklinGastoniaGoldsboroGreenvilleHampsteadHendersonvilleJeffersonLenoirLincolntonMcNairyMonroeMooresvilleMorgantonMurphyNew BernNewtonOak ViewRaleighRandlemanRobbinsvilleShallotteShelbyWaynesvilleWilkes
Date of Occurrence (If Applicable)
Reason for Nomination (Please Be Specific)
Which did the staff Represent?—Please choose an option—VisionMissionCore Value
If a Core Value, please specify which one:
