Totally "RAD" Award

Nominator Contact Information

*Name (if different from nominee)
*Title
*Affiliation
*Email Address
*Country
*Phone Number

About The Nominee

*Name
*Degree
*Title
*Affiliation
*Email Address
*City
*State/Province
*Country
*Briefly (2-3 sentences) tell us why your nominee should be selected as the Totally "RAD" Award recipient.
*Please upload one high-resolution photo.
JPG or PNG
*Please upload a brief (one-page) CV of the nominee.
DOC, DOCX
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The Foundation for Dermatology Education is a registered 501(c)(3) nonprofit organization located in Chicago, IL.