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Empowering Women & Shifting Legacies
Help Her Rise:
Nomination Form
Your name
*
First Name
Last Name
Your email
*
Nominee Name
*
First Name
Last Name
Nominee email
*
Nominee address
(Optional)
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Tell us about her?
*
What are her primary needs?
Thank you!