OTA AFA Community Surgeon Achievement Award Nomination Application

Complete the application to apply or to nominate a colleague.


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* 1. Please fill in the following fields:

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* 2. Who are you nominating?

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* 3. My nominee meets the following eligibility requirements:
- An active, Board certified, community orthopaedic trauma surgeon.
- A current member of the OTA.

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* 4. Describe how your nominee has demonstrated outstanding community orthopaedic contributions in the communities he/she serves including describing the community itself:  location, demographics, challenges met to serve (limit 250 words).

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* 5. Describe how your nominee has demonstrated an ongoing commitment to the advancement of orthopaedic research and education at the community level (limit 250 words).

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* 6. Describe your nominee's personal qualities of integrity, compassion and leadership in orthopaedic trauma.

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* 7. Upload Nominee CV - or email to erffmeyer@ota.org

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.