AWARD NOMINATION FORM - DOC
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AEROSPACE MEDICAL ASSOCIATION AWARD NOMINATION FORM 320 S. Henry Street Alexandria, VA 22314-3524 NOMINEE: ___________________________________________ Phone: (703) 739-2240 Fax: (703) 739-9652 www.asma.org AWARD: ____________________________________________ DATE: ____________________ PROPOSED CITATION: Summarize in your own words the specific achievement or contribution which inspired the nomination. Limit is 80 words. BACKGROUND: Succinctly describe the reason for the nomination, including dates and significance of relevant accomplishments, their impact in the larger world, and the ways in which they meet the requirements of the specific award. Use complete sentences without abbreviations. Limit is 300 words. Additional biographical material may be attached but is limited to 3 typed pages. NOMINATOR INFORMATION Name (print): ______________________________________________________________ Signature: ___________________________________________________ Date: _______________________ Address: __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ \ AWARD RULES Any member of the Association may submit a nomination for these awards by following the rules below. Award recipients are selected by vote of the Awards Committee: each committee member reviews the nomination forms and ranks the candidates based on the significance of the accomplishments cited, their relevance to the specific award, and the timeliness of the nomination. The committee chairperson does not vote and is not eligible for an award during his/her tenure. It is an Association policy that committee membership broadly represents both the disciplines of Association membership and the constituent organizations which are part of the Association, and that committee members rotate every 2-3 years. Rules: 1. The nominee must be a current member of the Association, with the sole exception that the Sidney D. Leverett, Jr., Environmental Science Awards is open to nonmembers. 2. Employees of a company sponsoring an award are eligible to receive the award. Self nomination is not allowed. Deceased members may be nominated. 3. Nominations for the Tuttle and Environmental Science Awards must cite a specific paper printed in Aviation, Space and Environmental Medicine. The award will be given to the first author only. 4. An individual can only receive one award in any one year. 5. The form is available on the AsMA website. You may either submit the nomination directly from the website or you may download the nomination form into your computer for e-mailing as a Word document attachment. Nomination forms sent via e-mail should be addressed to the Awards Committee Chair, Dwight Holland, at email@example.com; and Ms. Gisselle Vargas at AsMA Headquarters (firstname.lastname@example.org). If e-mail is not available, you can send a hard copy of the form via normal mail to: Dwight Holland 4874 Glenbrooke Dr. Roanoke, VA 24081 Phone: (540)761-1576 AsMA Home Office fax: (703)739-9652 Any auxiliary biographical material in electronic or hard copy attachments must be limited to 3 typed pages and will be retained in Association files. 6. Nominations received by Dec. 15 will be considered for awards to be presented at the next annual meeting. Unsuccessful nominations will be retained in the active file through three award cycles. AsMA ANNUAL AWARDS 1. LOUIS H. BAUER FOUNDERS AWARD 10. JOHN A. TAMISIEA AWARD Established to honor Louis H. Bauer, M.D., founder of the Established by the Civil Aviation Medical Association in Aerospace Medical Association. It is given annually for the memory of John A. Tamisiea, M.D. Awarded annually to an most significant contribution in aerospace medicine. Aviation Medical Examiner or other individual who has made an outstanding contribution to the art and science of aviation 2. MARY T. KLINKER AWARD medicine in its application to the general aviation field. Established by the Flight Nurse Section in memory of Mary T. Klinker, who was killed in a C-5A crash while performing a humanitarian mission. The award is given annually to 11. SIDNEY D. LEVERETT, JR. ENVIRONMENTAL recognize significant contributions to, or achievements, in, the SCIENCE AWARD field of aeromedical evacuation. In memory of Sidney D. Leverett, Jr., Ph.D., this award is presented annually to an individual who has made a significant 3. HARRY G. MOSELEY AWARD contribution in the field of environmental sciences through a Established in memory of COL Harry G. Moseley, USAF, MC, publication in Aviation, Space, and Environmental Medicine or in recognition of his material contributions to flight safety. It is by activities conducted in support of aerospace systems given annually for the most outstanding contribution to flight operations. safety. 12. JOHN PAUL STAPP AWARD 4. ERIC LILJENCRANTZ AWARD Established by Environmental Tectonics Corp. in honor of Col. Established in memory of the CDR Eric Liljencrantz, MC, USN, John Paul Stapp, USAF, MC. The award is given annually to whose brilliant career in aviation medicine was cut short by his recognize outstanding contributions in the field of aerospace death in an airplane accident in 1942. It is given annually to biomechanics and to promote progress in protection from injury honor excellence as an educator in aerospace medicine, or basic resulting from ejection, vibration, or impact. research into the problems of acceleration, altitude, or weightlessness. 13. KENT K. GILLINGHAM AWARD Established by AMST to honor the memory of Kent K. 5. THEODORE C. LYSTER AWARD Gillingham, M.D., Ph.D. The award is presented annually to an Established to honor the memory of Brig. Gen. Theodore C. individual who has made a significant contribution in the fields Lyster, the first Chief Surgeon, Aviation Section, U.S. Army of spatial disorientation and situational awareness related to Signal Corps. It is given annually for outstanding achievement flight. in the general field of aerospace medicine. 14. WON CHUEL KAY AWARD 6. BOOTHBY-EDWARDS AWARD Established by the Korean Aerospace Medical Association in Established in memory of Walter M. Boothby, M.D., pioneer honor of Won Chuel Kay, M.D., a the former Surgeon General aviation medicine researcher, and Howard K. Edwards, M.D., of the Korean Air Force, founder and first Medical Director of clinical practitioner of aviation medicine. The award is Korean Airlines and first President of the Korean Aerospace presented annually for outstanding research and/or clinical Medical Association. This Award is presented annually to a practice directed at the promotion of health and prevention of member who has made outstanding contributions to international disease in professional airline pilots. aerospace medicine. 7. JULIAN E. WARD MEMORIAL AWARD 15. MARIE MARVINGT AWARD Established by the Society of U.S. Air Force Flight Surgeons in Established by the French Aerospace Medical Association in memory of its first member to lose his life in an aircraft accident, memory of Marie Marvingt (1875-1963), a pioneer French pilot and to honor all flight surgeons whose lives have been lost in and surgical nurse who, for more than 50 years, actively and flying activities relating to the practice of aerospace medicine. untiringly involved herself in the conception and development of The annual award is for superior performance and/or outstanding air ambulance services and in the education of the general public achievement in the art and science of aerospace medicine during regarding their use and benefits. The award is presented annually residency training. to honor excellence and innovation in Aerospace Medicine. 8. RAYMOND F. LONGACRE AWARD Inquiries regarding the AsMA Awards nomination process Established to honor the memory of MAJ Raymond F. Longacre, should be directed to: MC, USA. It is given annually for outstanding accomplishment in the psychological and psychiatric aspects of aerospace Dwight A. Holland, Ph.D. medicine. E-mail: email@example.com 9. ARNOLD D. TUTTLE AWARD Established in memory of Col. Arnold D. Tuttle, USAF, MC. Awarded for original research that has made annually the most significant contribution toward the solution of a challenging problem in aerospace medicine and which was published in Aviation, Space and Environmental Medicine.