Meritorious Service Award Nomination

Deadline: Friday, August 11, 2023

This award is available to any member of the Association, an organization or group, or any person, in recognition of service that brings credit and prestige to the pharmacy profession. This award shall take the form of a suitable scroll, and may not be presented annually, but at the discretion of this Committee, who shall nominate appropriate persons, organizations or groups and make a decision for final approval by Council.

Meritorious Service 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
CAPTCHA
Name
This field is for validation purposes and should be left unchanged.

Meritorious Service Award Nomination

Meritorious Service Award Nomination

Meritorious Service Award

Nominee Information

Nominator Information

Seconder Information

Requirements

Submission Deadline: Friday, August 11, 2023

GET IN TOUCH

85 Thorburn Road, Suite 203

St. John's, NL

A1B 3M2

T: (709) 753 - 7881

T: (866) 753-7881

E: email@panl.net

QUICK LINKS