2022 CITIZEN OF THE YEAR AWARD

Nomination Information

Presented by the FVMA to honor the outstanding contributions of any non-veterinarian who helped advance the association and veterinary medicine.

NOMINATION DEADLINE - DECEMBER 3, 2021

If you have any questions, please call the FVMA office at 800.992.3862 or email us at: info@fvma.org

Name of Nominee *

Organization/Practice *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

Name of Nominating FVMA Member

Local VMA or Practice Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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

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

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