2022 LIFETIME ACHIEVEMENT AWARD

Nomination Information

Presented by the FVMA to a senior active or retired member who has made outstanding contributions to the Association and veterinary medicine.

NOMINATION DEADLINE - DECEMBER 3, 2021

The Lifetime Achievement Award is awarded to senior active and retired members who have made outstanding contributions to the Association and veterinary medicine.

To be eligible for this award, a nominee must have been a member (active or retired) of the Association for the last 30 consecutive years and must be at least 65 years old.

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

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* 1. Nominee Information

Name of Nominee *

Organization/Practice *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

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* 2. Nominator Information

Name of Nominating FVMA Member

Local VMA or Practice Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 3. Please list the nominee’s accomplishments and why they should be considered for the award.

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* 4. Attach a high-resolution photo of the nominee.

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* 5. If needed, you may also submit other information to support your nomination.

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* 6. If desired, you may use this option to upload any additional documents or photos.

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