Nominating the Physician of the Year 2017

The 2017 Physician of the Year award seeks to honor unique leadership qualities held by physicians within Placer and Nevada counties. The winner of this prestigious award will demonstrate a significant contribution to health care, be a leader for our community and be a true advocate for organized medicine. The Placer Nevada County Medical Society will honor this individual at our Membership Dinner on September 28, 2017.

Please fill out your contact information. If your nominee wins, we will need to contact you.
Deadline for Entry is Friday, July 14, 2017.

* 1. Your Name?

* 2. Your email address and phone number?

* 3. Sponsoring organization? (if applicable)

* 4. Nominee's Name?

* 5. Nominee's Area of Practice?

* 6. Nominee's Current Employer? 

* 7. Nominee's Work History? (If you wish to submit a CV in addition to this survey form, email to quinn@pncms.org)

* 8. Does this nominee hold any leadership positions among charitable/professional groups on a local, state or national level?

* 9. Please tell us why you believe this physician should be selected as the Physician of the Year for the PNCMS?

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