NAMS 2019 Award Nomination Form NAMS 2019 Award Nomination Form Please complete and submit the online Nomination Form before the deadline of June 10, 2019. Self-nominations are accepted. Note: the system will not permit large pasted documents. If your nomination includes a large document, please email the nomination to mary@menopause.org instead of using the online system. Question Title * 1. NOMINATION FORM Nominate candidates by selecting the award from the drop-down menu. As a reminder, self-nominations are also encouraged. 1.) NAMS/Thomas Clarkson Outstanding Clinical and Basic Science Research Award 2.) NAMS/Leon Speroff Outstanding Educator Award 3.) NAMS/Ann Voda Community Service Award 4.) NAMS Certified Menopause Practitioner of the Year Award 5.) NAMS Media Award 6.) NAMS/Irwin J. Kerber Membership Scholarship Endowment 7.) NAMS/Fernand Labrie Vaginal and Sexual Health Award for Junior Investigators 8.) NAMS Annual Meeting Trainee Scholarships Question Title * 2. Please provide the following information. Name of Nominee: * Address: * City: * State/Province: ZIP/Postal Code: Country: * Email: * Question Title * 3. Please indicate why this person/you should be considered (include CV if possible):Be sure to include any and all data pertaining to the award criteria. Question Title * 4. Please provide the following information about yourself. Your Name: * Address: * City: * State/Province: ZIP/Postal Code: Country: * Email: * Submit