2018 Outstanding MCMS Officer or MCMS Administrative Staff Award

Nomination Deadline: September 8

To be considered for the Dr. Henry & Page Laughlin Outstanding Officer Award, the physician must have served at least one term as an officer of the Society. To be considered for the Outstanding Administrative Staff Award, the nominee must be a current employee of the Society. Nominees for either award must have demonstrated extraordinary commitment and leadership to the Society. If you have questions or concerns, please call Susan or Karissa at 301.921.4300.

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* 1. Name of Nominee:

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* 2. Award for which Nominated:

Officer

Administrative Staff

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* 3. Address:

Street

Suite

City

State

Zip Code

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* 4. Nominee’s Telephone:

Day:

Evening:

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* 5. Nomination Submitted by:

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* 6. Your Telephone:

Day:

Evening:

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* 1. Name of Nominee:

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* 2. Award for which Nominated:

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* 3. Address:

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* 4. Nominee’s Telephone:

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* 5. Nomination Submitted by:

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* 6. Your Telephone:

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* 7. Please submit your personal statement (100 - 500 words) as to why you believe the nominee is worthy of the award for the indicated category.