1. Name of Nominee
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  2. Address
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  3. City, State
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  4. Zipcode
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  5. Phone
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  6. Number of years nominee has served agriculture:
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  7. Contributions to Nebraska Agricultue:
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  8. If applicable, list outstanding achievements in education, science, agribusiness or production agriculture:
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  9. Leadership positions held by nominee:
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  10. Other pertinent information:
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  11. Nominated by:
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  12. Date
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  13. Address
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  14. Phone
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