FILL OUT & RETURN THE FOLLOWING PAGE BELOW.

SEND IT TO ME BY MAIL TO:

Bob Baxter
BOX 1824
EVERETT, WA 98201
USA

OR BY FAX TO:	425-261-4210


Or, if you can scan the form after you have added your signature,
you can send it as an e-mail attachment to me at my address: 

bobaxter@sprynet.com 

PLEASE DO NOT SEND IT DIRECTLY TO AORN.

HEADQUARTERS STATES THAT ALL PARTS
OF THE AWARDS NOMINATION FORM
MUST ARRIVE TOGETHER FOR IT TO BE CONSIDERED.

-----------RETURN ONLY FORM BELOW/DELETE THESE INSTRUCTIONS---------
-------------------ADJUST FORM SO IT FITS ON ONE PRINTED PAGE----------------------

 
Section C:	Sponsor Form

Printed Name of Sponsor/Title:

Complete Address:


Work Phone:

Name of Applicant:	Bob Baxter RN, CNOR

Name of Award:	Award for Excellence in Perioperative Nursing

Sponsor's Relationship to Applicant
X Colleague

How long have you known the applicant and in what capacity?


In 100 words or less, discuss this applicant's outstanding contributions to perioperative nursing in support of this award.








Sponsor Signature and Title:

Date:

(Return this form to applicant when completed. Do NOT send to AORN.)