Doctors Manitoba | Award Nomination Form

Award Name *

Please select the Award that you are submitting a nomination for.

Nominator's Name *

Nominator's Email *

Nominator's Phone Number *

Candidate's Name *

Candidates Email *

Candidate's Phone Number *

Upload the following documentation (*indicates required documentation):

Curriculum Vitae*
List of academic or professional honours/awards*
Personal testimony from at least 2 individuals (min. of 1 non-physician testimony)*
List of publications and presentations
List of supporting awards and achievements (professional and personal)
Supporting press coverage

Additional Information *

Attach documentation here. To upload multiple files, please hold CTRL (Windows) or CMD (Apple).

Please include information for up to three references or contacts (Name, email, phone for each)

Name *	Email *	Phone *

The deadline to receive nominations is December 15, 2022

Search