Nomination Form

The nomination form for 2017 will be posted here from January 1, 2017.

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All fields marked with (*) are required

Nominee : Name*
Nominee : Title*
Nominee : Organization Name*
Nominee : Address*
Nominee : Telephone*
Nominee : Fax
Nominee : E-mail*
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Nominator : Name*
Nominator : Title*
Nominator : Organization Name*
Nominator : Address*
Nominator : Telephone*
Nominator : Fax
Nominator : E-mail*
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Supporter

Nominators should also complete the following and send us one supporting letter as hard copies or PDF files, or request one supporter to contact us.

Supporter : Name
Supporter : Title
Supporter : Organization Name
Supporter : Address
Supporter : Telephone
Supporter : Fax
Supporter : E-mail
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Scientific Achievements

Please summarize your nominee's scientific achievements (up to 2000 characters) citing primary published works of nominee (up to 10) from the list below, identifying references in text with arabic numerals in square brackets.

Scientific Achievements*

Primary Published Works

Please use Vancouver style (Uniform Requirements for Manuscripts Submitted to Biomedical Journals) for reference list. See example here: http://www.icmje.org/index.html#references.

Primary Published Works1*
Primary Published Works2
Primary Published Works3
Primary Published Works4
Primary Published Works5
Primary Published Works6
Primary Published Works7
Primary Published Works8
Primary Published Works9
Primary Published Works10

Nominator Recommendation

Please write your recommendation here, explaining why the nominee's achievements represent a major advance in either clinical or basic research in diabetes (up to 2000 characters).

Nominator Recommendation*

Characters other than indicated below cannot be entered:

abcdefghijklmnopqrstuvwxyz
ABCDEFGHIJKLMNOPQRSTUVWXYZ
0123456789
!"#$%&'()-=^~\|@`[]{};:+*<>,./?\_

※Please be cautious particularly when you copy the text and paste it in the body text.