American Society for Pain Management Nurses

Pain Management Advocacy Award

Please complete the application below, including uploading additional required attachments.

The ASPMN Pain Management Advocacy Award, established in 2004 by the ASPMN Board of Directors, is presented to an individual or group in recognition of outstanding contributions in promoting awareness of pain and its treatment through local, state, and national advocacy programs, governmental reform, and/or media exposure.

First Name *

Last Name *

Email *

Name of Nominee: *

Nominee Academic/Professional Credentials: *

Nominee Job Title: *

Nominee Current Employer: *

Nominee Phone Number: *

Nominee Email Address: *

Is the Nominee a Current Member of ASPMN? *

Yes

Nominee's ASPMN Involvement (List Board or Committee Involvement): *

If not addressed in the letter of recommendation, please describe how the leadership and outstanding contributions by the nominee which have influenced the public perception, attitudes and awareness of pain and its management through public education, governmental reform and/or media exposure compatible with the ASPMN mission and goals. *

Attach Documents with Evidence of Advocacy: *

Letter of Recommendation (Should not exceed two pages): *

Nominee's Current CV: *

Nominated By: *

Nominator's Phone Number: *

Nominator's Email Address: *