2020 OAFP Friend of Family Medicine Award Nomination Form
This award recognizes an elected official, member of the media (individual or organization), or community individual who has worked on, been involved with, or reported on issues related to family medicine in Ohio.
Email address *
First Name *
Your answer
Last Name *
Your answer
Address *
Your answer
Phone *
Your answer
Who are you nominating? (First, Last, and Title) *
Your answer
Name of Affiliated Governmental Body / Publication / Station *
Your answer
Nominee Email
Your answer
Nominee Address
Your answer
Nominee Phone
Your answer
Why would you like to nominate this individual? *
Your answer
Please send corresponding articles, broadcasts (date and title of story that aired is sufficient), or other examples of work that exhibit the nominee's support of family medicine to Communications Coordinator Lauren Heberling by emailing lheberling@ohioafp.org.
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