AFA/OTA Community Surgeon Achievement Award Nomination Application

Please complete the application to apply or nominate a colleague.  
Then, please email the nominees CV to Darlene Meyer:
Deadline:  March 15, 2018

Questions? Please call 847-430-5133.

* 1. Please fill in the following fields:

* 2. Who are you nominating?

* 3. I (or my nominee) meet the following eligibility requirements:

* 4. Please describe how you/your nominee has demonstrated outstanding community orthopaedic contributions in the communities he/she serves including describing the community itself:  location, demographics, challenges met to serve (limit 250 words).

* 5. Please describe how you/your nominee has demonstrated an ongoing commitment to the advancement of orthopaedic research and education at the community level (limit 250 words).

* 6. Please describe your or your nominee's personal qualities of integrity, compassion and leadership in orthopaedic trauma.

* 7. Please email the nominees CV to Questions?  Please call Darlene Meyer at 847-430-5133.