Exit this survey 1. The Nominee's Information Question Title * Name of the Nominee Question Title * Title/Professional Position Question Title * Institution/Organization/Company Question Title * Address Street: City: State: ZipCode: Question Title * Contact Information: Office Phone: Fax: Email: Home Phone: Question Title * Have you advised this individual that they are being nominated? Yes: No: Question Title * Would you like your nomination to remain anonymous? Yes No Question Title * Is your nominee a member of EWHC? Yes No Not Sure Next
