Friend of the Academy Award

Friend of the Academy Award

Please answer the questions below to nominate any individual or group which provided exceptional assistance to the Academy of Pelvic Health in the past year. This can include vendors, sponsors, contractors, or individuals that the Academy has worked with to achieve its goals.

DEADLINE EXTENSION: All nominations are due by 11:59pm Eastern Time, December 1, 2021.

Sender

Nominee's Full Name *

Company Name / Organization Name *

Relationship to the Academy of Pelvic Health Physical Therapy

E-mail *

What specific action or behavior did this individual or group exhibit that deems them deserving of this award and how was this action exemplary *

Examples could include supporting a board member, assisting with research, donating equipment, promoting a course etc.

How did this action benefit the Academy and/or its members? *

Nominator Information

Nominator's Name:

First Name Last Name

Nominator's E-mail:

example@example.com