Page 13 - Flying Physician Magazine Issue 1-2018
P. 13
MARK THOMAN FPA AWARDS
2018 Distinguished Service
Award
NOMINATION FORM
VICI DeHAAN
2018 Co-Pilot of the Year
Purposes of the Flying Physicians Association:
n To promote education and research related to medicine and aviation
n To promote aviation safety by research, education and dissemination of
information on medical factors affecting the operation of aircraft
n To stimulate interest in aviation medicine
n To offer assistance in the rapid movement of trained medical personnel, donor
organs, blood, patients and emergency supplies
n To encourage aviation activity among physicians for the betterment of the medical
profession
n To emphasize the use of aircraft in facilitating the practice of medicine
n To cooperate with civilian agencies engaged in the welfare of our country JOHN DAVIS
n To promote Samaritan and community service related to aviation medicine 2018 Airman of the Year
Date: ________________________ My name: ______________________________________________________
My phone: (____) - _______ - __________ My e-mail address: ________________________________________
I am nominating (Name of nominee) _______________________________________ for:
q Distinguished Service q Airman of the Year q Co-Pilot of the Year q Honorary Member
Accomplishments and contributions which qualify this person for this award (attach extra sheet if needed):
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Distinguished Service: Recipient must be a voting member of the Flying Physicians Association and have
contributed significantly toward the organization’s mission and goals.
Co-Pilot of the Year: Recipient must be the co-pilot of a voting member of the Flying Physicians Association and
have contributed significantly toward the organization’s mission and goals.
Airman/woman of the Year: Recipient has made a notable contribution to aviation medicine, to aviation safety
or education in aviation. It is not mandatory that the nominee be a licensed physician but should be associated in
allied sciences.
Honorary: It is not mandatory that the recipient be a physician. The person nominated will have made significant
contributions to aviation or aviation safety. Nominees will be submitted to the Executive Committee for approval.
Send this form to: The FPA Awards Committee, Roger Hallgren, MD, Chair; 109 Robert Circle, Belle Plaine, MN 56011
PHONE: 612.240.1714 E-MAIL: rbhallgren@hotmail.com
The Flying Physician vol. 61 - Issue 1 2018 13
