Nominee Name_________________________________________________________________
Address______________________________________________________________________
Phone_______________________________________________________________________
Position______________________________________________________________________
Title_________________________________________________________________________
Person Submitted by______________________________________________________________
Address______________________________________________________________________
Phone_______________________________________________________________________
Nominated for:
_________ PCR Patient Education Award
_________ PCR Professional Education Award
_________ PCR Rising Star/Rookie of the Year
_________ PCR Mentorship Award
_________ PCR Manufacturer/Distributor of the Year Award
_________ PCR Lifetime Achievement Award
Deadline for these Fall awards is
AUGUST 31st, BUT IT'S NEVER TOO EARLY!
Describe how your nominee qualifies for this award using the
specific criteria stated in the by-laws:
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
Please print out and mail or fax nomination form before the deadline to:
CHRISTINE HERB, RN, BSN, CETN
29720 Avenida La Vista
Cathedral City, CA 92234
Home: 760-778-3678
Work: 760-612-2622
Fax: 760-778-2731
E-mail: ETNgem@aol.com
Thank you.