Award Nomination Form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Nominator Name *FirstLastNominator Email *Name of Person Being Nominated *FirstLastAward Category *Distinguished Service AwardDistrict Leadership AwardFederal Legislative AwardFreshman Legislator of the YearHealth Care Legislator of the YearHonorary RecognitionMedallion Award - AuxiliaryMedallion Award - Osteopathic CollegeMedallion Award - HospitalMedallion Award - ProfessionalMedallion Award - PublicMemorial DesignationPhysician of the YearDate of Death (for Memorial Designation only)Reason for Nominating *Submit
