2019 SDSMA Awards Nomination

Please click "OK" to proceed to the nomination form.

Question Title

* 1. Nominee:

Last name

First name

Designation (Dr./Ms./Mr./Mrs.)

City

State

Title/position

Organization

Question Title

* 2. Nomination is for the following award(s):

Check the box for the award(s) you are nominating the above individual. Individuals may be nominated for more than one award.

Distinguished Service Award

Outstanding Young Physician Award

Community Service Award

Young at Heart Award

Richard P. Holm, MD, Media Award

Question Title

* 3. Nomination submitted by:

Nominator must provide their name and be a current SDSMA member or group of members.

First name

Last name

Designation (MD or DO)

Email address

Title/position

Organization

Question Title

* 4. Statement of nomination

Statement should indicate why the nominee should receive the award(s). Provide highlights of the nominee’s contributions to the field of medicine and/or the SDSMA, or any specific information related to the qualifications for the award(s).

Note: If you would like to submit any supporting materials (letters, testimonials, article clippings, pamphlets, CV, etc.), please email it to ereiss@sdsma.org.