Fresno Madera Medical Society

2017 Physician Community Service Award

Lifetime Achievement
Recognize a Deserving Colleague!

The Medical Society will bestow an award recognizing a physician who has gone
beyond the call of duty in providing for the health and welfare of our community's
residents during his or her lifetime.

Criteria for this award includes: Extraordinary service and dedication to patients, the
community or to the profession, uncompensated services performed, high quality of
care provided to patients

Previous award recipients: Drs. Morton Rosenstein, Alex Moir, Andre Minuth, David Hodge,
Fitzalbert Marius, John Bonner, James Caffee, Roger Larson, Gilbert Roth , Robert West, Ronald
Smith, Dwight Trowbridge, Lauren Grayson, Harold Hanson, John Murray, Max Millar, Ed Defoe,
Thomas Eliason, Fred Cooley, Robert Peters, Jack Schiff, Burton James, Donald Knapp, Sathaporn
Vathayanon, Jack Thorburn, Joseph Woo, Steven Parks and John Conrad.

Nominations from the past three years will be considered. The recipient is selected by
the FMMS Historical Committee and approved by the FMMS Board of Governors. The
award will be presented at the Medical Society's November 17, 2017 dinner and
installation gala.

Please complete and return the form below by OCTOBER 9, 2017. Completed forms
can be mailed or faxed. You are welcome to email nominations to nbutler@fmms.org.
If you have any questions please contact FMMS.

2017 Physician LIFETIME ACHIEVEMENT Award

I nominate____________________________________________________________________________________, MD
(Please give specific and detailed examples for your nomination, if needed attach additional paper)

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Submitted by: _________________________________________________________Phone:_______________________

Mail to: Fresno-Madera Medical Society

255 W. Fallbrook Ave., Suite 104
Fresno, CA 9371
Fax to: (559) 224-0276