Rock Doc and AMP (Affiliated Medical Professional) Champ Nomination Form

Rock Doc and AMP (Affiliated Medical Professional) Champ Nomination Form

- Nominations will be reviewed and the Rock Docs/AMP Champs will be determined by the Illinois CancerCare Foundation Advisory Board.
- The presence of the Rock Doc/AMP Champ winners at the CUREageous event on Friday, November 10, 2017 is required.
- Nominations are not valid from year to year but previously nominated physicians may be re-submitted for consideration.
- All forms must be returned by June 30, 2017.