ICC 2020 Award Nominations

Fill out the below submission form to nominate someone for the ICC award! Please send any supporting images or documentation to Mary@indianacancer.org.
Email Address *
Your answer
Nominee Name (First, Last, and Credentials) *
Your answer
Nominee Organization *
Your answer
Nominee Address *
Your answer
Nominee Phone Number *
Your answer
Which award is this nomination for? *
Is this person/organization a members of the ICC? *
Tell us why you are nominating this person for an ICC award. *
Your answer
Nominated By: *
Your answer
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