Survey - Nominate a Candidate for Man & Woman of the Year 2021 - The Leukemia & Lymphoma Society of Canada

Nominee information: Please fill out the following fields about the person you are nominating.

*

Question - Required - Candidate First Name

*

Question - Required - Candidate Last Name

*

Question - Required - Why are you nominating this person?

Question - Not Required - If "other" please specify

*

Question - Required - Candidate Company / Business

*

Question - Required - Candidate Job Title

*

Question - Required - Candidate Phone Number

*

Question - Required - Candidate Email Address

Your information