2022 DISTINGUISHED SERVICE AWARD

Nomination Information

Presented by the FVMA for exceptional achievements and contributions by a member toward the advancement of veterinary medicine and the profession.

NOMINATION DEADLINE - DECEMBER 3, 2021

The Distinguished Service Award is awarded for exceptional achievements and contributions by a member toward the advancement of veterinary medicine and the profession.

To qualify, a member must have been dedicated to veterinary medicine and given time and energy beyond reasonable expectations.

To be eligible for this award, a nominee must have been an active member of the Association for at least the past 15 years.

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

Question Title

* 1. Nominee Information

Name of Nominee *

Organization/Practice *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

Question Title

* 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 *

Question Title

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

Question Title

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

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

Choose File

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

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

Choose File

Question Title

* 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.

Choose File

2022 DISTINGUISHED SERVICE AWARD

Nomination Information

Question Title

* 1. Nominee Information

Question Title

* 2. Nominator Information

Question Title

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

Question Title

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

Question Title

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

Question Title

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

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