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* 1. Please enter your contact information

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* 2. Are you a member of ASCCP (note: only members may nominate someone for an award)?

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* 3. If another ASCCP member seconds your nomination, please include their contact information below.

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* 4. Name of the ASCCP member you are nominating

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* 5. Select the Award you are nominating this member for:

Lifetime Achievement Award
The purpose of the Lifetime Achievement Award is to recognize the contributions of individuals of any Nationality to the field of endeavor encompassed by our Society. The Award is for a ‘lifetime corpus of work’ in any area that has contributed to basic or clinical science or to the development of outstanding educational tools for the improvement of patient care. A brief description of the nominee’s contributions should accompany the nomination.

Distinguished Scientific Achievement or Service Award
The "Distinguished Scientific/Service" award is the highest award offered by the Society and is presented for outstanding scientific achievement or service to the discipline of anogenital & HPV-Related Diseases.

Meritorious Service Award
The "Meritorious Service" award recognizes exemplary service to the Society or discipline of anogenital and HPV-related diseases.

Award of Merit for Scientific Achievement or Service
The "Award of Merit" recognizes those individuals who have served the Society in a specific capacity (e.g., Board or Committee work), or have otherwise completed a scientific activity of merit.

Burton Krumholz Lifetime Legacy Award
Recognizes an individual who has donated significant enduring materials to the society [such as images/slides sets] or been responsible for an ongoing long-term project.

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* 6. This award can be for the Members' Science or Service. Please select which one you are nominating them for:

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* 7. Please describe why you are nominating this member for the award.

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