Your Name:________________________________________
Your Phone:________________________________________
Your Email:_________________________________________
Name Of Individual Being Submitted:_____________________
__________________________________________________
Relationship:_______________________________________
Please describe in fifty words or less why this individual
was first in her field or endeavor:_____________________
__________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
Please print this form and fax to: 334-4985
Copyright 2008 First Women of Kern County

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