Thrombosis ëLeaders of the Futureí Awards

Nomination Form

The Thrombosis ëLeaders of the Futureí Awards have been established by the Thrombosis Quorum to recognise young health care professionals for their vision of current and future directions and innovations in clinical practice that they feel may directly improve the prevention, diagnosis or management of thrombosis.

Senior clinicians are encouraged to invite members of their staff to participate.ÝÝ Health care professionals below the age of 35 years, who are involved in the management, prevention or diagnosis of thrombosis within the UK, including (but not exclusively):

- Cardiology - General practice - General medicine - Care of the elderly - Haematology - Pathology

- Neurology - Surgery (orthopaedic, vascular, general) - Nurses - Pharmacy This list is not exhaustive

Health care professionals who are over the age of 35 years will also be considered if they have been practising in their profession for under 7 years.

If you know of anyone who is eligible for entry to the Awards and may be interested in receiving written information from the Thrombosis Quorum, please fill in their details below.

Name
Present Position
Department
Postal Address
		Post Code
Tel No.	Fax No.
Email

Please return this form to:

Thrombosis Quorum Secretariat

PO Box 4253, London W1A 6ST

Tel: 020 7318 8307Ý Fax: 020 7318 8349

E-mail:Ý secretariat@thrombosisquorum.co.uk