GHXcellence Award

GHXcellence Awards Nomination Form

Submission Deadline: March 19, 2021

Questions? Summit@ghx.com

AWARD
SUBMITTER INFORMATION
e.g. XXX-XXX-XXXX
NOMINEE INFORMATION
e.g. XXX-XXX-XXXX
NOMINEE INFORMATION FOR ORGANIZATION #2 (COLLABORATION AWARD)

Below, please enter contact information for the (other) collaborating organization(s):

e.g. XXX-XXX-XXXX
COLLABORATION AWARD
INNOVATION AWARD
COMMUNITY IMPACT AWARD
SUPPLIER CUSTOMER SERVICE AWARD
HEALTHCARE HERO AWARD
KEY CONTRIBUTOR

If applicable, provide the name of a specific individual who was a key contributor in this effort.

KEY CONTRIBUTOR FOR ORGANIZATION #2 (COLLABORATION AWARD)

If applicable for organization #2, provide the name of a specific individual who was a key contributor in this effort.