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The Chrysalis Award recognizes an individual or group for their outstanding advocacy work for/on behalf of survivors of domestic or sexual violence. Please submit nominations by September 27 and join us at the Candlelight Vigil on October 6 for the presentation.

NOMINEE INFORMATION
Name
First Name *
Last Name *
Address
Country
Address Line 1
City
State/Province
Postal Code
Phone
Preferred Phone
ext Extension
NOMINEE QUALIFICATIONS- Please include at least one contact method for the Nominee
The Chrysalis Award recognizes an individual or organization engaged in outstanding advocacy work to/on behalf of survivors of domestic or sexual violence. Please describe the nominee's work in this area.
What qualities or activities make this nominee especially deserving of this award?
NOMINATOR INFORMATION
Name
First Name *
Last Name *
Address
Country
Address Line 1
City
State/Province
Postal Code
Phone
Preferred Phone
ext Extension

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