JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Nominate a COVID All-Star
Thank you for taking a few minutes to highlight a member of the Victoria medical community who has made an exemplary contribution to the COVID preparation and work.
Sign in to Google
to save your progress.
Learn more
What is your name?
Your answer
What is your email address (in case we would like more details)?
Your answer
Who are you nominating?
Your answer
Tell us a bit about why this person deserves to be a COVID All-Star.
Your answer
Is there anything else you'd like us to know?
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of South Island Medical Staff Association.
Report Abuse
Forms
