Thank you for completing a nomination for the American Stroke Association Regional Stroke Awards. The American Stroke Association, a division of the American Heart Association, realizes the importance of recognizing individuals that help further our mission of building healthier lives, free of cardiovascular diseases and stroke. Two awards will be presented at The NorthEast Cerebrovascular Consortium (NECC), 8th Annual Summit to be held on October 17-18, 2013 at the Westin Waterfront - Boston, MA. Nominees for these awards can include geographic representations from the Founders Affiliate eight state region of: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Rhode Island and Vermont. Please note the following: Complete the entire form. Please type the information using appropriate upper and lowercase characters and do not use all caps. Be sure to click the Submit Button at the bottom of the form to ensure we receive your nomination. For questions, please contact Shannon Melluzzo at Shannon.Melluzzo@heart.org or (413) 735-2104.

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* 1. Nomination submitted by:
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* 2. Award Candidate is being nominated for:

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