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Pro Bono Publico Awards - Nomination Form

Nominee Information

Name of Nominee
Has this person been nominated previously? Yes   No   Don't Know
If Yes, What Year?
Title/Position
Firm/Organization
Race/Ethnicity (optional)
Address
Address
City
State
Zip
Day Phone
Evening Phone (optional)
Fax (optional)
Email

Categories

Please indicate one category that most closely describes nominee's present position or activity

Private practice   Judiciary   State, local, diversity or specialty bar leader  
Non-profit   Government   Academia  
Corporate/business sector   Other (please explain)

Nominator Information

Name of Nominator                                         
Title/Position
Firm/Organization
Address
Address
City
State
Zip
Day Phone
Evening Phone
Fax
Email
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Updated: 1/16/2009

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