Awards Nomination Form For 2019
AMWA encourages nominations for our 2019 National Awards. Help us recognize exceptional contributions to medicine and to AMWA. DEADLINE: SEPTEMBER 1, 2018 (Except for the Anne C. Carter Student Leadership Award, which is DECEMBER 3, 2018.) **All submissions will be confirmed within 3 days of receipt; should you not receive a confirmation, please contact us at email@example.com.** Required Documentation: (1) Submit your personal statement as to why you believe the nominee is worthy of the award. (2) Include the nominee’s current CV and contact information. Other supporting papers may be attached with the nomination. Note: In order to be eligible for the award, the awardee must be present at the Awards Presentation Ceremony at the MWIA Centennial Meeting that will be held on July 25-28, 2019 in New York, NY.
Nominations (click only one)
Elizabeth Blackwell Award
Woman in Science Award
Bertha Van Hoosen Award
Camille Mermod Award
Lila A. Wallis Women's Health Award
Anne C. Carter Student Leadership Award
Esther Pohl Lovejoy Award
Dr. Larry Zaroff Man of Good Conscience Award
Nominee Phone Number
Submit your personal statement as to why you believe the nominee is worthy of the award.
Include the nominee's current CV and any additional information.
Please upload a copy of Curriculum Vitae below.
If your nominee is not selected, would you like a letter sent to this person notifying them of their nomination?
Agreement and Electronic Signature
By submitting this application, I affirm that I am a national AMWA member.
Should be Empty: