2022 GOLD STAR AWARD

Nomination Information

Presented by the FVMA to a member who has contributed much of their time and energy to the Association and/or a local association for the advancement of veterinary medicine and the profession.

NOMINATION DEADLINE - DECEMBER 3, 2021

The Gold Star Award is awarded to members who have contributed much of their time and energy to the Association and/or a local association for the advancement of veterinary medicine and the profession.

To be eligible for this award, the nominee must have been an active member of the Association for at least the past three (3) years.

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.

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

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