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IMS 2023 Member Nomination Form
This form is for IMS Members who wish to nominate a member physician, resident or student for open IMS leadership positions. Nominations close Tuesday, February 28, 2023.
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(Nominator) Please provide your name *
(Nominator) Please provide contact information (email address and phone number) *
Who are you nominating? (Name of nominee and designation) *
Nominee's email and/or phone number
What is their specialty? *
What is the nominee's status?
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What is the name of the nominee's clinic/organization and where it is located? *
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