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IdHIMA Distinguished Member Award Nominating Form

Distinguished Member Award Nominating Form
 
The following form is to be completed and submitted to the State President when a nomination is made for the Distinguished Member Award:
Nominee:
This question requires a valid email address.
This question requires a valid date format of MM/DD/YYYY.
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Nominee is a member in good standing with AHIMA and IdHIMA: *This question is required.
Select at least TWO of the following criteria met by the nominee: *This question is required.
Nomination submitted by:
This question requires a valid email address.