Judge Application Form – eHealthcare Leadership Awards

Name*

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Organization*

Job Title*

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Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Category Expertise

In which award categories do you have sufficient expertise to evaluate entries? View descriptions of the categories here. (Check all that apply.)

Healthcare Website Experience/Knowledge

With which types of organizations do you have sufficient expertise to judge entries? View descriptions of these group classifications here. (Check all that apply.)

Language Expertise

(English is assumed, since it is the language of administration.)

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To apply to be a judge for the eHealthcare Leadership Awards, please fill out this form:

Application to Judge