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CEAI Star Nomination

CEAI Star Nomination Form

Please nominate a member of the CEAI Community who stands out in one or more of the following pillars: Leadership, Technical Ability, Teamwork, and Innovation

Nominee's Name *

First

Last

Nominee's Title and Position *

Facility/ Hospital (where nominee works) *

Company if Applicable

Nominee's Email *

Nominee's Phone Number *

Please tell us why this person is a CEAI Star

Please include details of talents, events, etc… that demonstrate why this individual is a CEAI Star.

Your Name *

First

Last

Your Email *