AWARDS NOMINATION FORM

AWARD NOMINATIONS DEADLINE: December 29, 2023.
Please complete the following information to nominate a deserving person to be considered for the awards to be presented on Friday, March 8. A CV must be submitted for consideration of the nomination. If you would like to submit documentation or other materials, articles, etc to support your nomination, email those to Susan D'Antoni at sdantoni@masela.org no later than December 29, 2023. Questions? Call 504.302.1900 or email sdantoni@masela.org. Thank you.
Criteria:
*All nominees and nominators must be physicians (MDs or DOs)
*Neither the nominator or nominee must be a MASELA Member to be considered.
*Self-nominations will not be considered. 
*Posthumous awards will be considered if the physician-nominee died within the last 18 months.
*Nominations by a physician family member of a nominee will be considered.
*For consideration, scope of work must be relevant and more recently performed.
*One award will be given in each category.
*Awardee must be able to attend the Celebration to receive the award.
Incomplete nominations will not be considered. 

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* 1. Nominator's Information

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* 2. Nominee's Information

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* 3. For Which Award Do You Want the Nominee to Be Considered?

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* 4. What is your relationship with the nominee?

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* 5. REQUIRED: Please provide a brief statement (300 words or less) about why you think this nominee is deserving of this award:

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* 6. OPTIONAL: Please provide any additional information to support your nomination. Limited to 300 words or less.

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