The American Randonneur Award Submission Form

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                            American Randonneur Nomination Form


       I ____________________________________________________       RUSA# __________
                    your name                                               your #

       hearby nominate ______________________________________       RUSA# __________
                        nominee's name                                     nominee's #


                            To receive the American Randonneur Award


                                        Send this form to:


                                        Johnny Bertrand
                                        858 Carrick Pike
                                       Georgetown KY 40324

                                    Deadline is December 15th