Friends of ASCLS-WI Award
The purpose of this award is to recognize institutions that demonstrate continuous support of ASCLS-WI and the profession of clinical laboratory science. Please fill out the information below for the member submitting the nomination and the institution. The institution will be mailed a letter of appreciation and be presented with an award at the ASCLS-WI State Convention. This award is pertaining to the last calendar year and should be submitted by April 1.
ASCLS-WI Member Name
ASCLS-WI Member Phone
ASCLS-WI Member Email
If the institution is unable to send a representative to accept the award at the State Convention Awards Ceremony, would you be able to accept the award on behalf of the institution?
Clear selection
Never submit passwords through Google Forms.
This form was created inside of Roche. Report Abuse