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JPAC Gratitude Program Form

Your name*
Your email address*
Name of colleague you would like to recognize*
Colleague email address if you know it (we can help if you don’t know it)*
Briefly describe what you are expressing your gratitude for (maximum 1500 characters)*
Please choose one of these options:*	You have my permission to use my submission and my name publicly (on the AMA website and in AMA publications). You have my permission to use my name in my message to the recipient, but not publicly. I would prefer to keep my submission anonymous (we won't identify you in the email to the recipient or use your message publicly).

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Alberta Medical Association