ACLP Applc Special Recognition 2024

1. Your contact details *This question is required.

First name
Last name
Credentials (MD, etc.)
Email

2. Are you nominating yourself or another? *This question is required.

Is your nominee aware that you are nominating them? *This question is required.

3. The nominee you are submitting for this award *This question is required.

First name
Last name
Credentials (MD, etc.)

4. Reason for your nomination *This question is required.

5. Please upload the nominee's CV (MS-Word or PDF file formats only; max file size 1MB; please include the nominee name in the filename) *This question is required.

File: {{filename}} delete

6. Please upload nominee's portrait photo. Photos are not used in judging and only the photo of the award winner is used for annual meeting program presentation purposes. Accepted file formats: png, gif, jpg, jpeg; max file size 1MB *This question is required.

File: {{filename}} delete

7. Please provide a 150-word bio for the nominee in a format that could be referenced in advertising or read aloud when introducing the nominee as an award winner at the annual meeting. This information will not be used in the judging process. *This question is required.

8. Please provide the phonetic spelling of the nominee's name