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Nominee Name: 
Class Year: 
Qualities:
Please provide a brief narrative on the qualities of the nominee:
Honors, Awards:
List honors, awards and distinctions
Alumni Organization Affiliations:
Name of alumni organizations with which nominee is affiliated. If more than one, list all.
Nominee's Address:
Home Phone: 
Business Name: 
Title: 
Business Address:
Nominator Name:
Nominated by
 
Are you a Richmond alumnus/a? Yes
 No
If yes, list class year: 
Address:
Home phone: 
Business phone: 
E-mail Address: