CACME 2017 CME Awards Nomination Form

CACME Awards 2017

Nomination Deadline: June 2, 2017

Question Title

* 1. Are you a CACME member?

Yes

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* 2.
Nominator Information

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Relation of Nominator to the Nominee(s)

Email Address

Phone Number

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* 3. Nominated for which award?

Most Outstanding CME Activity

Outstanding CME Collaboration

Award for Research in CME

Ted Lewis Lifetime Achievement Award

If you are nominating someone for the Ted Lewis Lifetime Achievement Award, please send nomination letter describing the individuals contributions to CACME and/or CME/CE in Colorado to -your email address. Limited to 2 documents.

Email it to:Carlos.Ferreira@iaslc.org

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* 4.
Nominee Information:

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 5. 1. Are there other persons or organizations involved in the activity being nominated? (If yes, please identify them in box below).

Yes

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* 6. Please identify persons or organizations involved.

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* 7. Please provide the exact title of the activity/project, describe it and tell the committee why you think it merits the award (great outcomes, innovative strategy, etc.)

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* 8. Electronic Signature of Nominator:(please type your name below)

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* 9. Upon submission of this electronic form, the nominee(s) will be notified at the address(es) provided on this form.
Please enter today's date:

Date

THANK YOU FOR YOUR PARTICIPATION

Question Title

* 1. Are you a CACME member?

Question Title

* 2. Nominator Information

Question Title

* 3. Nominated for which award?

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* 4. Nominee Information:

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* 5. 1. Are there other persons or organizations involved in the activity being nominated? (If yes, please identify them in box below).

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* 6. Please identify persons or organizations involved.

Question Title

* 7. Please provide the exact title of the activity/project, describe it and tell the committee why you think it merits the award (great outcomes, innovative strategy, etc.)

Question Title

* 8. Electronic Signature of Nominator:(please type your name below)

Question Title

* 9. Upon submission of this electronic form, the nominee(s) will be notified at the address(es) provided on this form.Please enter today's date:

* 2.
Nominator Information

* 4.
Nominee Information:

* 9. Upon submission of this electronic form, the nominee(s) will be notified at the address(es) provided on this form.
Please enter today's date: