Champions of Health Care Individual Nominations

NOMINATE AN INDIVIDUAL

SUBMIT THE FORM BELOW TO NOMINATE AN INDIVIDUAL FOR A CHAMPIONS OF HEALTH CARE AWARD.

Please email any supplemental materials such as resumes, bios, etc., to marketing@timesfreepress.com.*

*Supplemental materials are encouraged but not required.

How did you hear of this program?

To confirm, are you nominating an individual? To nominate an organization, use the organization nomination form.

Yes

Individual Award Category

Nominee First Name

Nominee Last Name

Nominee Title

Nominee Organization

Nominee Email

Nominee Phone

Nominee Street Address

Nominee City

Nominee State

Nominee Zip

Nomination Narrative

Is this a self nomination?

Yes

Your First Name

Your Last Name

Your Email

Your Phone

Your Street Address

Your City

Your State

Your Zip

What is your relationship to the nominee?

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