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Use this form to nominate a doctor of your choice to receive the Physician of the Year Award or the Researcher of the Year Award.  We look forward to your response.

Please provide the name of the person you are nominating:

Name
Organization
Work Phone
FAX
E-mail

Please enter the reason for your nomination, with particular attention to the criteria:
The Physician of the Year Award recognizes physicians practicing in the region or who have recently retired for excellence in clinical care, teaching, and service to the profession or the community.
The Researcher of the Year Award is presented to one or more  physicians whose research has significantly affected clinical practice in their area, and who may not be widely recognized in our region. Please submit the nominee's CV or list of research submitted pr accepted for publication to a recognized journal.

 

 

 

 

 

 

 

 

 

Please provide your name:

Name
Title
Organization
Work Phone
FAX
E-mail
URL

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