Champions of Health Care Organization Nomination

NOMINATE AN ORGANIZATION

SUBMIT THE FORM BELOW TO NOMINATE AN ORGANIZATION 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 organization? To nominate an individual, use the individual nomination form.

Yes

Organization Award Category

Organization Type

Organization Name

Name of Top Executive (CEO, etc.)

Street Address

City

State

Zip

Organization Website

Name of Contact Person at Organization

Contact Person's Email

Contact Person's Phone

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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