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AT Practice In Ohio (documents)
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Team Physician Award Nomination Form
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Last Name
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First Name
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E-mail address
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Confirm E-mail
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NATA/OATA Membership Number
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OATA Membership District
Northeast
Northwest
Central
East
Southeast
Southwest
Out of State
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Date Submitted
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Phone Number
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Nominee's Last Name
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Nominee's First Name
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Nominee's Place of Employment
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Nominee's E-mail
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Nominee's Confirmed E-mail
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Nominee's OATA District
Northeast
Northwest
Central
East
Southeast
Southwest
Out of State
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Nomination Justification
Explains the reasons award is deserved, the qualities possessed that make the nominee worthy of the award, what getting the award would mean to the nominee.
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