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Nominated for: Ethel Bond Memorial Consumer Award

Nominee Information

Name:
Title
Health Center/PCA Affiliation
Street Address
City	Waukegan
State	IL
Zip Code	60085
Phone	847-377-8073
Email	zwllfs@egeenf.com
Membership Status	Is a member
NACHC Indivfidual Member Number (6 digits required)	105446

Initial Nominator Information

Name
Title
Health Center/PCA Affiliation
Street Address
City	Springfield
State	IL
Zip Code	62701
Phone	217-541-7305
Email:	szldqi@liqpcm.com
Membership Status	Is a member
Member Number	205769

Nomination Statement:

Supporting Nominator 1

Name
Title
Health Center/PCA Affiliation
Street Address
City
State
Zip Code
Phone
Email
Membership Status
Nominator's NACHC Individual Member Number
Declaration of Support
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