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X-Factor Awards Nomination Form

Nominate an X-ceptional Techie (age 35 or Under) and his/her X-traordinary Innovation!

The X-Factor Awards honor the creators of truly innovative ideas, products or processes.

This form is the only way to nominate an individual. The form must be completely filled out to be accepted. All fields are required.

Nominee Information:

Name:	Age:
Company/Title (if applicable):	Student Status (if applicable):
Email	Daytime Telephone Number:
I'm nominating this person for (select one category): Best start-up entrepreneur Most innovative student Most innovative techie in the workplace Person whose innovation will likely have the biggest potential impact on technology

Nominated By:

Your Name:	Title:
Company or Organization:	Email address:
Daytime Telephone Number:
Please tell us (in 500 words maximum) why your nominee deserves to be recognized as an X-ceptional techie:
Please provide contact information for another reference for your nominee:
Name:	Title:
Company or Organization:	Email address:
Daytime Telephone Number:
Enter the code you see above. This is case-sensitive:

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