NYCRA Distinguished Member of the Year Award

NYCRA Distinguished Member of the Year Award

Award Nomination Form
NYCRA recognizes members who have made outstanding contributions to the cancer registry field, both locally and nationally.

The Distinguished Member Recognition is awarded at the Annual Educational Conference and is based on peer nominations.

Please complete this form with as much detail as possible—your submission may be the primary information used in the review process.
Eligibility Reminder:
Nominee must be a current NYCRA member in good standing to be eligible for recognition.
Submission reminder:
All nomination forms and narrative summaries must be submitted by: 9/1/2026
Nominee:

First NameLast Name
Title:
Employer:
Address (home/work):

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address:
example@example.com
Phone Number:
Format: (000) 000-0000.
Please provide a detailed narrative explaining why you are nominating this individual. Include specific examples that demonstrate their contributions to the cancer registry field:
I am nominating this person for the NYCRA Distinguished Member of the Year Award because:
Details
Nominated by:

First NameLast Name
Employer:
Your E-mail Address:
Your Phone Number:
Format: (000) 000-0000.
Was the individual notified of the nomination?
Will the individual attend the conference?
Today's date:

MonthDayYear
Date
Note: Nominees do not need to be present at the Annual Educational Conference to be recognized. Selected recipients will be notified in advance and encouraged to attend.
Should be Empty: