Bowl of Hygeia Award Nomination

Deadline: Friday, August 11, 2023

This award may be presented annually to a member of the Association who fulfills the terms of reference laid down by the donor, viz. Exceptional service to the community through the profession of pharmacy. ALL nominations must be made on the prescribed form and must be proposed and seconded by members of the Association.

Bowl of Hygeia Award

Nominee Information
Name*
First Last
Address*
Street Address Address Line 2 City Province Postal Code
Email*
Phone*
Nominator Information
Nominator Name*
First Last
Nominator Address*
Street Address Address Line 2 City Province Postal Code
Nominator Email*
Nominator Phone*
Nominator Signature*
Seconder Information
Seconder Name*
First Last
Seconder Address*
Street Address Address Line 2 City Province Postal Code
Seconder Email*
Seconder Phone*
Seconder Signature*
Does the Nominee know they are being nominated?*
- Yes
- No
Requirements
Checklist*
These documents must be included with this nomination form.
- Completed Nomination Form
- Minimum two ( maximum five) letters of reference
- CV or biography of nominee
- Background documentation to demonstrate achievement (i.e. publications, ads, testimonials)
Upload required documents*
Drop files here or

Max. file size: 256 MB.
Submission Deadline: Friday, August 11, 2023
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Bowl of Hygeia Award Nomination

Bowl of Hygeia Award Nomination

Bowl of Hygeia Award

Nominee Information

Nominator Information

Seconder Information

Requirements

Submission Deadline: Friday, August 11, 2023

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