Hall of Fame Nomination
Please fill out the form below.
What is your full name?
*
First Name
Last Name
What is your email address?
*
example@example.com
What is your phone number?
*
Please enter a valid phone number.
Name of person you would like to nominate?
*
What type of work did this person do?
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Doctor
Nurse
Management
Clinical Support
Non-Clinical Support
Is this person living?
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Yes
No
Please provide a statement of the candidate's contributions to OGHS as it relates to the nomination criteria (or upload your statement below).
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If you prefer to upload a document with your statement (two-page max)
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