PRO TIPS: 

  • Please fill out the following form carefully and completely, noting all of the required fields. 
  • All email addresses must be in valid xx@xx.xx format. 
  • 16 MB limit on all file uploads.
  • Your nomination is only submitted once you have reached a screen with a green top bar saying “Thank you for taking this survey”. 
  • Files and supplemental materials may be emailed to awards@aami.org. 
  • Please direct any questions or support needs to awards@aami.org. 
 

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* 1. Name of AAMI Technical Committee of Working Group:

Current Chair Contact Information:

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* 2. Name:

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* 3. Company/Affiliation:

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* 4. Mailing Address:

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* 5. Phone Number:

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* 6. Email Address:

Current Co-Chair Contact Information (if applicable):

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* 7. Name:

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* 8. Company/Affiliation:

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* 9. Mailing Address:

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* 10. Phone Number:

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* 11. Email Address:

Nominator Information:

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* 12. Name:

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* 13. Title:

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* 14. Company/Affiliation:

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* 15. Mailing Address:

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* 16. Phone:

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* 17. Email:

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* 18. Basis for the Award: Please describe the importance of the contributions, benefits and effects that resulted/will result from the work of this committee (e.g., contribution to patient safety, international trade, etc), the efficient/effective operations of the committee and/or other factors that should be taken into considered in the evaluation of this committees work:

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* 19. Other Committee Activities and Achievements: Please describe any other committee activities that the selection committee should take into account in deciding on the award, such as assisting AAMI with educational courses related to the standard(s), authoring articles about the standard or technology covered by the committee, commenting on standards of other organizations, etc.:

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* 20. Please enter your name verifying this information is true to the best of your knowledge:

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