2023 William Prusoff Memorial Award Nomination
Please complete the form below to submit your nomination.
Nominee Information
Nominee's Full Name
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First Name
Last Name
Nominee's Institution
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Nominee's Phone #
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Country Code
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Area Code
Phone Number
Nominee's Email
*
Confirmation Email
Basis for Nomination (accomplishments, scientific stature, service to antiviral research, other)
*
Nominator Information
Nominator's Full Name
*
First Name
Last Name
Nominator's Institution
*
Nominator's Phone #
*
-
Country Code
-
Area Code
Phone Number
Nominator's Email
*
Confirmation Email
Upload Additional Files - Optional
Additional Supporting Documentation (upload up to 3 files)
Upload Files
Nomination letter, CV, etc.
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