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MHIMA Distinguished Member Award Nomination Form

Part I: The Nominee

Note: It is suggested that the group or individual nominating this candidate inform the nominee that they are proposing his/her name to guarantee that the information submitted is accurate.
NEW!! If you do not have all of the information needed to complete your request, you can "save and continue later" at the top of the screen after you select "Next" below. Please note that your request will not be sent until you SUBMIT your request.
1. About the Nominee
2. Nomination submitted by