2019 IHS Awards Nomination Form

IHS Award Nomination Form

Please fill out this form to nominate an individual or group for an IHS award.

1. Choose the Award
Choose the Award

IHS James P. Lovell Advocacy Award IHS Outstanding Professional Member Award IHS Emerging Professional Award
Reason For Nomination
Explain why your nominee deserves the selected award (minimum 200 words).

2. Nominee Information
Nominee's Name

First Name Last Name
Nominee Designations (if applicable)
i.e., MA, ACA, BC-HIS
Nominee's Phone Number

Area Code Phone Number
Nominee's E-mail Address
Nominee's Business Name

Nominee's Address

Business Name
Street Address
City	State / Province
Postal / Zip Code	Country

3. Your Information
Your Name

First Name Last Name
Designations (if applicable)
i.e. MA, ACA, BC-HIS
IHS Member Number
Your E-mail Address
Your Phone Number

Area Code Phone Number

Your Address

Business Name
Street Address
City	State / Province
Postal / Zip Code	Country

You may submit supporting documentation for your nomination (e.g articles, press releases). To do so, click "Browse Files" to attach documentation.
Browse Files

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