Submission Form: Zelia Celona PTA Award

Please complete the following application and submit a letter.  The letters should describethe candidate's engagement in the profession and professional advancement along with examples of compassion for peers and patients.   

Please submit these letters to riapta@libertysquaregroup.com 

This award will be presented at the Annual Meeting 

(* Denotes Required Fields)

Nominee Information

Name of Nominee Nominee's current employer Name and contact of person submitting Please list 2 references and email contact. The committee may choose to follow up with these references. Reference 1 Name and contact Reference 2 Name and Contact

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