AMA Award NOMINATION FORM Please enable JavaScript in your browser to complete this form.Award Category (Select One):AMA Lifetime Achievement Award (Age 60+)AMA Young Achiever Award (Age below 40)1. Nominee Details:Full Name *Designation: *Institution / Organization: *Date of Birth / Age: *Contact Number: *Email ID: *2. Nominated By:Full Name *Designation: *Institution / Organization: *Contact Number: *Email ID: *3. Achievements Summary: (Please mention key achievements and contributions towards medical sciences and society) *4. Supporting Documents (Attach if available):Documents Type: *Curriculum Vitae (CV)Recommendation LetterProof of Achievements / Publications / AwardsUpload Here Click or drag files to this area to upload. You can upload up to 10 files. 5. Eligibility Criteria (for reference):Please Choose from below *Unblemished careerContribution towards medical sciencesContribution towards society6. DeclarationI hereby declare that the information provided above is true to the best of my knowledge.Signature of Nominee: *Date *Submit
