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Noi~inees are requested to complete the following and return it to the Southern <br />Piedmont Health Systems Agency; P. O. Box 35588; Charlotte, NC 28235, Please <br />give your personal response to the following questions. Completed nomination <br />forms must be received in our office by November 16, 1981. [If you need more <br />space, feel free to enclose an additional sheet for your answers.] <br /> <br />WHAT IS YOUR PARTICULAR INTEREST AND COMMITMENT 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 />