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2014 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

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* Your Contact Information

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* Name of Professor of the Year Nominee

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* Nominee's Professional Contact Information

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Affiliation

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* Please enter a short paragraph listing your nominee's merits as a Junior Fellow professor.