NAMS 2019 Award Nomination Form

NAMS 2019 Award Nomination Form

Please complete and submit the online Nomination Form before the deadline of June 10, 2019. Self-nominations are accepted.

Note: the system will not permit large pasted documents. If your nomination includes a large document, please email the nomination to mary@menopause.org instead of using the online system.

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* 1. NOMINATION FORM

Nominate candidates by selecting the award from the drop-down menu. As a reminder, self-nominations are also encouraged.

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* 2. Please provide the following information.

Name of Nominee: *

Address: *

City: *

State/Province:

ZIP/Postal Code:

Country: *

Email: *

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* 3. Please indicate why this person/you should be considered (include CV if possible):
Be sure to include any and all data pertaining to the award criteria.

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* 4. Please provide the following information about yourself.

Your Name: *

Address: *

City: *

State/Province:

ZIP/Postal Code:

Country: *

Email: *