Gold Medal Award Nomination Form - Washington State Radiological Society

Deadline for nominations: July 28, 2024

The Washington State Radiological Society board seeks nominations for the society’s Gold Medal Award. The WSRS bylaws state the following:
- The award shall be for outstanding service to radiology and radiologists of Washington, or for meritorious scientific achievement that reflects credit upon radiology in Washington
- The award is not obligatory each year
- The recipient shall have been a member of the WSRS for at least five years
- A nominee shall be member in good standing with the ACR
- Nominations shall be presented to the Chair at least three months prior to the date of any duly selected interim meeting or the date of the annual business meeting. The Board may nominate suitable candidates for such award on its own
- Approval of a nominee shall require a two‐thirds vote of the Board
- The award should not be made posthumously, except when the recipient has died following his or her selection
Nominator Information
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email
Phone
Nominee Information
Nominee Name
First Last
Nominee Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Nominee Phone
Nominee Email
To your knowledge, does the nominee meet the eligibility requirements as described in the by-laws (see above):*
- Yes
- No
Describe the nominee's impact on the field of radiology and allied healthcare fields in Washington State. (This can represent noteworthy service to the profession, particularly meritorious scientific achievement or distinction in education and mentorship).
Explain how the nominee has been an outstanding example of a professional in the field of radiology, radiation oncology or clinical medical physics.
What leadership positions has the nominee held within the WSRS, ACR or other professional societies? If possible, describe achievements he or she accomplished while in those positions.

Nominator Information

Nominee Information