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Endo All Star Nomination Form

Do You Know An Endo All Star?
We’d like to honor those who make the endoscopy world successful!

Please Note: As you cannot submit a photo with this web-based application, please e-mail the photo to Kathy Dix at kdix@vpico.com, or send it via U.S. mail to:

Kathy Dix
Virgo Publishing
3300 N. Central Ave., Ste. 300
Phoenix, AZ 85012

Photographs should be vertical (so they are suitable for a magazine cover), and digital photos should have a resolution of at least 300 dpi at 8" by 10".

Endo All Star Nomination Form

1. Name of nominee:

2. Experience:

3. Published articles:

4. Community involvement/recognition:

5. Contributions to endoscopy suite team:

6. What makes this team deserve the "all star" rating?

Thank you for your nomination! If you have any questions about the program or the magazine, feel free to contact Editor, Kathy Dix, at: (480) 990-1101 x. 1597, or at kdix@vpico.com.

Your Information

Your Name:

Address:

City:

State:

ZIP:

Phone:

Email Address:

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