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CPHIMA Distinguished Member Nomination Form

1. About the Submitter *This question is required.
This question requires a valid email address.
2. About the Nominee *This question is required.
3. Employment
Present Employment Status
4. Association Involvement

Instructions: Identify the association by name and list most recent activity first, including dates in each category.
5. Contributions to HIM
6. Letter of Recommendation

*file must be uploaded as a PDF