SurveyMonkey Powered Online Survey

Each year, the ICCS presents the Wallace H. Coulter Award to an individual from anywhere in the world in recognition of his or her lifetime contributions to the science, education and practice of Clinical Cytometry. This prestigious award carries with it an honorarium, and the awardee presents the Keynote lecture at the annual Clinical Cytometry meeting.

ICCS members are invited to submit a nomination. Please note that current ICCS officers are not eligible to receive the Wallace H. Coulter Award. The deadline to submit a nomination is May 8, 2020.

YOUR INFORMATION

Question Title

Name

Question Title

Are you a member of the ICCS?

Yes

Question Title

Which affiliated society are you a member of? (Required if not an ICCS member).

ESCCA

CCAS

ICCS-India

ISLH

ISAC

AFCC

GRCF

NOMINEE INFORMATION

Question Title

Nominee Contact Details:

Name *

Company

Email Address *

ICCS 2020 Wallace H. Coulter Award Nomination Form

Question Title

Name

Question Title

Are you a member of the ICCS?

Question Title

Which affiliated society are you a member of? (Required if not an ICCS member).

Question Title

Nominee Contact Details:

Question Title

What is the Nominee's general field of interest?

Question Title

Briefly describe the accomplishments of this nominee and why you think he or she merits this award.