Blue Faery Award Application Blue Faery Award Application Name* First Last Email* Main Phone*Personal Website Professional ExperienceEmployer*Job Title*Work Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Work Website* Upload CV*Accepted file types: pdf, doc.Upload Letter of IntentRequired for those applicants conducting new researchResearch Summary*Provide a brief summary of the applicant’s research published in peer-reviewed journals during the years 2017 – 2018. Links to publications are not acceptable.Tell Us More! (optional)Professional OrganizationsBoard MembershipsHonors/AchievementsFOR OUTSIDE NOMINATIONSPlease fill out this section if you are nominating someone else for the BFA.Tell Us About The NomineeBriefly tell us why you are nominating this person for the BFA and what your relationship is to him/her. Outside Nomination Acknowledgment To the best of my knowledge, the above information about the nominee is true and accurate. ELIGIBILITY ACKNOWLEDGMENTEligibility Criteria*I (or the person I nominated) meet the following criteria for the Blue Faery Award I have conducted research within the past two calendar years and/or will be conducting new exploratory research focusing on the various areas of primary liver cancer (HCC). I hold a Ph.D., M.D., or equivalent degree awarded before the submission deadline (January 31, 2019). I am employed by a non-profit institution including, but not limited to, universities and research hospitals. I have not received the Blue Faery Award in the previous three years. CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.
