WRS Flaherty Award Nomination Form

Flaherty Award Nomination Form

Recognition for contributions to the advancement of the practice of radiology. Volunteer service in leadership roles to the practice of medicine. Demonstrated lengthy service to the practice of radiology. Suitable candidates are identified and approved by the WRS Board of Directors. Awardees are notified by the President and the asked to attend the WRS spring annual meeting to be presented the award. A plaque is presented to the awardee and brief remarks are given. There is no lecture required or cash award provided.
Nominated Person*
Affiliation
Position
E-mail*
Phone Number*

Area CodePhone Number
Nominator:

Person submitting the nomination
Full Name*

First NameLast Name
Affiliation*
Position*
E-mail*
Phone Number*

Area CodePhone Number
Nominee Information

Please indicate details about your nomination
Why does this person deserve the Flaherty Award?*
Should be Empty:

Flaherty Award Nomination Form