2020 TAAP Professional of the Year Nomination

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* 1. Who are you nominating?

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 2. Is the nominee a current TAAP member?

Yes

No

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* 3. List any awards or accomplishments of the nominee

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* 4. Why are you nominating them?

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* 5. How do they influence or advance the field of addiction?

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* 6. Additional information you may want to add

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* 7. Your name

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* 8. Your email

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* 9. Your phone number