October 1999 Bulletin

AAOS HUMANITARIAN AWARD CANDIDATE NOMINATION FORM

General Guidelines

NOMINATION INFORMATION: PLEASE COPY THIS FORM AND PRINT OR TYPE

1. Sponsor:

Name:

Address:

Tel: Fax: E-mail:

Number of years you have known candidate:

Relationship to candidate:

2. Candidate

Name:

Address:

Tel: Fax: E-mail:

Candidate age: AAOS member since:

Candidate willing to attend 2000 Annual Meeting to receive award: _ Yes  _ No

3. Briefly tell us why you believe your candidate should be considered for the AAOS Humanitarian Award.

Fax or mail this form to: Barry Gainor, MD, c/o Anna Santillan, AAOS Humanitarian Award, American Academy of Orthopaedic Surgeons, 6300 N. River Rd., Rosemont, IL 60018; Fax: 847. 823. 8027.


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