First Name
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Last Name
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Email Address
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ESCRS Membership ID (If Available)
Affiliation/Institution
Nomination Type
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Peer-Nomination
Self-Nomination
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First Name
Last Name
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Contribution
Nominee's Contribution to the ESCRS (Please Tick All That Apply)
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Scientific Presentations (Free Papers, Posters, Symposia, Videos etc)
Educational Contribution (Instructional Courses. Wetlabs/Drylabs, Subspeciality Programmes)
Leadership Roles (Committees, Chair Positions, Mentorship)
Innovation & Research (New Technologies, Clinical Studies, Programme Development)
Other Notable Contributions (Please Specify)
Maximum 500 Words
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Brief Statement of Impact
Please briefly describe how the nominee’s work has significantly contributed to ESCRS and the field of ophthalmology:
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Maximum 750 Words
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Endorsement
If applicable, an ESCRS leader or peer may provide a short statement of support.
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