Award Nomination Form

To be completed by STARFLEET Medical Corps and all SFI members who –

1. have a current paid membership in STARFLEET International.

2. have designated their affiliation with STARFLEET Medical in the SFI Database.

3. have registered with STARFLEET Medical on the Directorate.

4. have been awarded the SFMD (COM 101 or MDPR 101 or MD-100 & MD-110 (including all Marine qualifications for this course).

5. have met all the course requirements for the Award for which they are making an application.

(Please list required courses when asked. Do not state they can be found in the SFI Database. Some requirements have course options and not listing required courses could result in you not receiving the Award.)

All member actions from June 2012 to the present will be considered for Award recognition.