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Please note, there is no autosave. If you leave this page before clicking "Submit," your nomination will not be received.

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* 1. Name of Nominee:

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* 2. Nominee's degree? 

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* 3. Institution

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* 4. Are you self-nominating?

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* 5. What is your name, and email address?

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* 7. Which position(s) do you wish to nominate the individual for?

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* 8. Comments:

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* 9. You may upload a CV/ Resume of the nominee. (optional)

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Clicking "Submit" will send your nomination to ATS. You may submit additional nominations using new survey form. Please email Miriam Rodriguez at mrodriguez@thoracic.org with any questions.
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