2024 Annual Medical Service Awards Nomination Form

Event is Thursday, October 10, 2024 at The Forest Country Club

All nominees must be US citizens and legal residents of Lee County Florida. Nominees do NOT need to be members of the Lee County Medical Society. Anybody can nominate. For Physician nominations, they must have practiced in the past or still have their practice located within Lee County.

(Please only use this for one nomination submission at a time)

Physicians Nomination selections are on page 1, NON Physician selections can be found on page 2. Only 1 SELECTION can be picked.

DEADLINE is AUGUST 9, 2024

Question Title

* I choose to nominate a PHYSICIAN for one of the following categories:

Citizenship and Community Service Award: For outstanding leadership and/or public service above and beyond the call of duty as a practicing physician. This can include service within the local community or abroad, such as, but not limited to, contributions to international aid missions or other pro bono work

Scientific Achievement Award: This award is given in recognition of outstanding work in the areas of scientific medical research. This will include both basic science and clinical research. Work done while residing within the county will be emphasized although previous research outside of the region will be considered

Health Education Award: This award will recognize the professional or public health education activities of a physician. This may include those exemplary physicians who educate other physicians and health care workers. Physicians involved in non-promotional community service education will also be considered.

Leadership and Professionalism Award: This award will underscore the County Medical Society’s continuing dedication to the principles of medicine and the highest standards of medical practice. The ideal candidate for the award would:
1. Have distinguished himself/herself as a leader in medicine within our community or beyond.
2. Have made an outstanding contribution through active service in the medical community, improving the profession's
effectiveness, upholding the practice of medicine through advocacy of policies, provision and/or the organization of services,
and/or scholarly writings that demonstrate effective leadership and professionalism

Lifetime Achievement Award: Nominees should have contributed substantially to the goals and ideals of the medical profession. The nominees' contributions shall have been sustained and substantial over a significant term of service in Lee County.

In Memory of an Outstanding Physician Award: In memory of an outstanding physician for substantial contributions to our medical community. This may include, but not necessarily be limited to, lasting and significant achievements in the areas of community service, scientific or clinical research, medical education, leadership, medical ethics or professionalism. Nominee must have practiced or worked in Lee County

2024 Annual Medical Service Awards Nomination Form

Event is Thursday, October 10, 2024 at The Forest Country Club

Question Title

* I choose to nominate a PHYSICIAN for one of the following categories:

Question Title

* To access NON PHYSICIAN categories, leave this page blank and click the NEXT button to select your category.