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3505 E. Frontage Rd.
Suite 315
Tampa, FL 33607
800-749-2257 phone
813-636-8122 fax
info@aakp.org

  
Nomination Form

The Medal of Excellence is an American Association of Kidney Patients’ recognition program that honors a renal physician for his or her extraordinary skills and devotion in the renal field. The award recipient and nominees will be honored at the Medal of Excellence Award Dinner to be held on Sunday, March 11, 2007. Each year, the Award Dinner is held in conjunction with the Renal Physicians Association’s Annual Meeting.

Eligibility:
Any person who has been a renal physician for at least five years and who has achieved outstanding success in caring for kidney disease patients.

Selection:
The recipient will be selected by a review panel of renal community leaders and professionals.

The recipient is chosen on the basis of information submitted. Careful completion of the nomination form and supporting materials is critical to the evaluation of the candidate’s qualifications.

A company may submit up to three nominations. Self-nominations are accepted and encouraged.

Nomination Form:
The nomination form is available online (as a downloadable .pdf file) and through the National Office. Click here to download the file (you can type directly onto the downloaded form then print to mail/fax to AAKP). To obtain a nomination form, you can also call (800) 749-AAKP.

Deadline for Nominations:
Nominations must be received on this nomination form. The form may be photocopied. Nominations must be postmarked by Dec. 5, 2006. Please mail nomination forms to:

American Association of Kidney Patients
Medal of Excellence
3505 E. Frontage Road, Suite 315
Tampa, FL 33607

The form may be faxed to (813) 636-8122.

Please contact Diana Clynes (dclynes@aakp.org) or Leticia Messam (lmessam@aakp.org) or call (800) 749-AAKP for more information.


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