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Nominees are requested to complete the following and return it to the Southern <br />Piedmont Nealth Systems Agency; Suite 425, One Charlottetown Center, 1300 Baxter <br />Street; P. O. Box 35588; Charlotte, NC 28235. Please give your personal response <br />to the following questions. Completed nomination forms must be received in our <br />office by April 18, 1983. Jif you need more space, feel free to enclose an <br />additional sheet for your answers.] <br /> <br />WHAT IS YOUR PARTICULAR INTEREST AND COMNITMENT TO HEALTH AND HEALTH CARE IN <br /> YOUR COMMUNITY AND IN OUR REGION? <br /> <br /> WHY DO YOU WISH TO SERVE ON THE GOVERNING BODY OF THE SPHSA? <br /> <br /> Nominee's Name <br /> <br /> <br />