Philadelphia Academy of Surgery Nomination Form Philadelphia Academy of Surgery Nomination Form Name of Nominating Fellow Name of Candidate for Nomination Institution of Candidate for Nomination Email of Candidate for Nomination Attest I attest that I am a dues-paying Fellow in good standing of the Philadelphia Academy of Surgery. The candidate I am nominating for fellowship in the Academy is Board Certified in a surgical specialty. The candidate will bring credit to and enhance the scientific mission of the Academy and I recommend the candidate without reservation. Yes Additional comments (if desired) Name of Second Nominating Fellow
