CMA Honourary Membership Nomination Form

The Canadian Medical Association (CMA) Honourary Membership is awarded to a person who has distinguished themselves in medicine, science, the humanities, or who has made significant contributions to the Medical Society of PEI (MSPEI).

With the award comes the distinguish of being appointed as honorary member to the Canadian Medical Association.

The nominee must: be in good standing with MSPEI and CMA; be 65 years or older; be member of MSPEI and CMA for the past 10 years.

Nominations are reviewed by the Nominating Committee, approved by the MSPEI Board of Directors and recommended to the CMA Board of Directors for approval.

Please note both the nominator and nominee must be members of MSPEI.

The deadline to nominate (or self-nominate) is noon on Friday, February 26, 2021.

Nominator Information:

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* 1. First name:

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* 2. Last name:

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* 3. Email:

Nominee Information:

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* 4. First name:

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* 5. Last name:

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* 6. Summarize why you think this colleague should be honoured with the CMA Honourary Membership Award (Note: In no more than 500 words summarize their career accomplishments and how they have contributed to the profession and/or the field of medicine.)

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* 7. Name two colleagues (first and last name) who endorse this nomination.

Attachments permitted include the CV of the nominee, letters of support and other relevant information.

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* 8. Supporting documents (optional):

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

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Thank you for your submission!