Nomination Form

Shine A Light… on an “everyday leader” physician who’s making a difference

With Shine A Light, the AMA recognizes and celebrates outstanding Alberta physicians for their unwavering commitment to caring for their patients; to ensuring that their patients receive top-quality, coordinated care; to seeking patient-centred ways to improve the delivery of health care in Alberta; and to always seeing the people in their patients.

Do you know a physician who goes above and beyond to care for his/her patients? If yes, please complete this nomination form.

Fields marked with an asterisk (*) are required.

Shine A Light nomination form

Type of nomination (please select one)*	I am a physician nominating a colleague I am a patient nominating a physician I am a health care colleague nominating a physician
Your name*
Your email address*
Name of nominee*
Nominee email address*
Nominee phone number*
Briefly describe why you are nominating this physician (Maximum 300 words)*

Alberta Medical Association

Nomination Form

Shine A Light… on an “everyday leader” physician who’s making a difference

Shine A Light nomination form