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The Medical Society will bestow an award recognizing a physician who has gone beyond the
call of duty to devote his or her time to a one-time or on-going special project or service
locally, statewide, nationally or internationally, that served(s) to promote the welfare and
healthcare of the community or the medical profession.
Previous award recipients are: Drs. Christopher Perkins, Marc Lasher, Richard Whitten, Jr.,
Walter Byerly, Chun. C. Chan, David Pepper, Chun-Wai Chan, Lee Snyder, Womens Imaging
Specialists in Healthcare, Mohammad Arain, John Telles, Joan Voris, Alex Sherriffs and Charles
Touton.
Nominations from the past three years will be considered. The recipient is selected by the
FMMS Historical Committee and approved by the FMMS Board of Governors. The award will
be presented at the Medical Society's November 17, 2017 dinner and installation gala.
Please complete and return the form below by OCTOBER 9, 2017. Completed forms can be
mailed or faxed. You are welcome to email nominations to nbutler@fmms.org. If you have any
questions please contact FMMS.
I nominate_____________________________________________________________________MD
(Please give specific and detailed examples of your nominees project or service)
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Submitted by:_____________________________________________Phone:_________________________