American Society for Pain Management Nurses

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

The ASPMN Distinguished Service Award, established in 2000 by the ASPMN Council of Past Presidents, is presented to a member of ASPMN in recognition of outstanding leadership, participation, and contributions toward achieving the goals of ASPMN . Self nominations are encouraged.

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): *

Leadership and contributions to pain management nursing have been demonstrated by: *

Leadership and contributions to the goals of ASPMN have been demonstrated by: *

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

Nominee's Current CV: *

Nominated By: *

Nominator's Phone Number: *

Nominator's Email Address: *