AAAM Award Nomination Submission
Please provide the required details to submit your nomination.
Please select the award category for your nomination (only one option may be selected):
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Award of Merit
A.J Mirkin Service Award
Elaine Wodzin Young Achiever Award
Donald F. Huelke Lifetime Membership Award
Jan Price Excellence in AIS Teaching Award
Achievements in Low- and Middle-Income Country Road Safety Award
Are you submitting a self nomination for this award?
Yes
No
Nominator Full Name
*
First Name
Last Name
Nominator Organization
*
Nominator Email Address
*
example@example.com
Nominator Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Who are you nominating for an AAAM Award?
*
First Name
Last Name
Nominee's Organization
Nominee's Email Address
example@example.com
Nominee's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Nominee's CV
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This is a requirement for the Achievement in Low- and Middle-Income Country Road Safety Award.
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Nominee's LinkedIn Profile
Please let us know why you feel this individual should be nominated for the chosen award:
*
Nomination Upload
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For nominations that exceed the 1,000 character limit above, please upload a document with your written recommendation for the Nominations and Awards Committee to review
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Submit Nomination
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