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Online Nomination Form--2009 AMA-YPS Young at Heart Award


AMA Young Physicians Section
2009 Young at Heart Award
Nomination Form

All nominees for the award should be AMA members who are not eligible for Section membership (i.e., over the age of 40 and/or within the first eight years of practice following completion of residency/fellowship and ineligible for membership in the AMA Resident and Fellows Section) whose support and guidance have strengthened the Young Physicians Section. This can be through:

  • organizational aid (such as developing a local young physicians section)
  • support of YPS issues in reference committees/caucuses or on the floor of the AMA House
  • support of YPS leadership development, i.e., promotion of YPS leaders.

Nominations will be accepted from AMA-YPS Assembly members only--either via e-mail, letter or fax--until December 31, 2008. Nominations may also be made in person at the AMA-YPS Interim Meeting in Orlando on November 7, 2008). The AMA-YPS Governing Council will consider all nominees, make a decision on the award recipient, and announce the winner in the 2009 Annual Meeting Delegate Handbook. The award will be given during the A-2009 AMA-YPS Assembly meeting in Chicago.To nominate an individual, complete the following online form.

The information you provide below is solely for the AMA's internal use and will not be resused or sold for any commercial purpose without your permission.

*Asterisk indicates required field.

*Nomination from:

*Your E-Mail Address:

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*Name of physician you wish to nominate:

*Contact information for nominee. Include mailing address as well as phone number:

*Rationale for nomination:

 
Last updated: Nov 4, 2008
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