NOMINATION
FORM
Lyn Piercy
Distinguished Achievement Award
COUNCIL ON RENAL NUTRITION - NORTHERN CALIFORNIA/NORTHERN NEVADA
(INCLUDE C.V.)
Name________________________________________________________________________________
Present
Position________________________________________________________________________
Business
Address______________________________________________________________________
Home
Address_________________________________________________________________________
Business Phone____________________________
Home Phone_________________________
Education_____________________________________________________________________________
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(20 points) CRN Activities (specify local/national; list offices, committee chairs, committee
participation, project
development).
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(5 points) Publications
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(5 points) Educational Material Developed
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(10 points) Public Speaking done on Renal and/or General
Nutrition
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(2 points) Participation in Other Professional
Organizations
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(5 points) Participation in Local KF Affiliate
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(10 points) Active Attendance at bi-monthly Local CRN
Meetings
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You may use this space to develop any of the criteria listed above or any other matters which you feel should be
considered in support
of the nomination:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
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MAIL TO THE CRN CHAIRPERSON
BY APRIL 1st.
Past recipients
1984 Sandy Smith/DeTar, R.D.
1985 Mary Pat Kelly, M.S., R.D.
1986 Trudy O-Regan-Esry, R.D.
1987 Linda McCann, R.D.
1988 Chhaya Patel, M.A., R.D.
1989 Mary Denny, R.D.
1991 Carol Gee, R.D.
1992 Marilyn Aaron, R.D.
1993 Joyce Yamaguchi, R.D.
1994 Sandy Gustafson, R.D., C.S.
1995 Connie Schroepfer, M.S., R.D.
1997 Marilyn Mayfield, M.S., R.D.
1999 Marty Torres, R.D., C.S.
2000 Kathy Hunt, R.D.
2001 Kelly Ackert, R.D.