Honorary Milestones in EVH Nomination

Honorary Milestones in EVH Application

Information for nomination

If you are interested in nominating someone for this honorary program or becoming a member yourself, please fill out the information shown here for review by a Getinge team member.

Are you nominating someone else, or yourself? *

Someone else

Myself

Number of EVH cases performed *

First Name *

Last Name *

Title *

Facility *

Your Email address *

Nominee's email address (optional)

Street Address *

City *

US State *

ZIP Code *

Additional Comments *

By submitting the information requested on this Honorary Milestones in EVH Nomination Form, you agree that Getinge will use the following categories of personal information to evaluate whether the nominee can qualify for the Honorary Milestones in EVH program: (i) identifiers, and (ii) facility where the nominee is employed.

If you are accepted into the Honorary Milestones in EVHe= we will notify you via the email address provided and will request additional information to include on the Honorary Milestones in EVH page on our website.