ACOG District II2014 ACOG District II Junior Fellow Professor of the Year

Nomination Form

 
Please complete the following information to submit a nomination for the 2014 ACOG District II Junior Fellow Professor of the Year.
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Your Name
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Your Residency Program Name
Your Contact Information
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Name of Professor of the Year Nominee
Nominee's Professional Contact Information
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Please enter a short paragraph listing your nominee's merits as a Junior Fellow professor.