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2. Your Name*
3. Your Phone Number*
5. Your Email*
7. Name of Veteran or Service Member Suggested as Speaker*
9. Is Suggested Speaker Veteran or Active Military

   1. Active Military
   2. Veteran
10. Branch of Military

    1. Air Force
    2. Army
    3. Marines
    4. Navy
    5. Other
12. Has Veteran or Service Member Served in War or Conflict
    If yes, please provide that information.
14. Phone Number*
15. Please Upload Picture of Veteran or Service Member Being Nominated*
    Maximum size allowed: 5 MB Allowed types: .gif, .jpg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt
17. Please Describe Veteran or Service Member's Service and Reason for Nominating Him/Her as Speaker*
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19. 1. Receive an email copy of this form.
20. Email address

    This field is not part of the form submission.

21. Submit

* indicates a required field