GHIMA Award Nomination Form
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Please support GHIMA by recognizing the outstanding contributions made by its members. Take a look at some of the previous
GHIMA award recipients
and
learn more about the awards
. The nomination deadline is April 30th.
To complete the Established Professional Award Application
click here
.
1.
About the Nominee
First Name
*
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Last Name
*
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Credentials
Title
Company Name
Street Address
City
State
Zip
Email Address
*
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Phone Number
*
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2.
Please indicate award for the nomination submitted
*
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Champion Award
Clinical Site Award
Distinguished Member Award
Distinguished Service Award
Mentor Award
Outstanding New Professional Award
Professional Achievement Award
Recent Graduate Award
3.
Reasons why the nominee deserves this award.
*
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4.
Nomination submitted by
First Name
*
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Last Name
*
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Credentials
Title
Company Name
Email Address
*
This question is required
Phone Number
*
This question is required