2025 Physician Advocate of the Year Nomination Form

Nomination for Physician Advocate of the Year

Please submit this form by February 16, 2026.

If you have questions, email kstone@osma.org.
Who are you nominating for the award?
First Name
Last Name
Title
Organization
Email
Phone
Address
Street address
City
State Zip

This nomination is submitted by:

Name
First Name
Last Name
Title
Organization
Email
Phone
Address
Street Address
City
State Zip
Please provide a brief biographical statement about nominee. (Additional information may be emailed below.)
Please indicate why your nominee should receive the Physician Advocate of the Year award. You may include letters, testimony, new clippings, pamphlets, etc.

Provide any supplementary documents via email to kstone@osma.org

   - denotes required fields