AWARD NOMINATION FORM - DOC

							                                            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: __________________________________________________________________________________

         __________________________________________________________________________________

         __________________________________________________________________________________


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                                              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
dwightholl@aol.com; and Ms. Gisselle Vargas at AsMA Headquarters (gvargas@asma.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: dwightholl@aol.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.