2021 Awards Nominations

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

Question Title

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

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

Note: The COPIC Humanitarian Award nomination form is found at the following link: Click here. For other awards, proceed through the current form.

Community Service Award

Distinguished Service Award

Outstanding Young Physician Award

Richard P. Holm, MD, Media Award

Young at Heart Award

Question Title

* 2. Nominee:

Last name

First name

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

City

State

Title/position

Organization

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 for SDSMA awards (article clippings, pamphlets, CV, etc.), please email it to ereiss@sdsma.org.