Candidate Typepersonal" "From a third party"]
Third party name
Phone
Name of the center / hospital
Actor name
Identity card/passport number
Expiry Date
Job Title
City
Please tell us in no more than 300 words about the new center, program, device, technology or service you are nominating
Please tell us in no more than 300 words how this center, program, device, technology or service will help improve treatment options for childhood cancer.
Please tell us in no more than 300 words about the potential impact this center, program, device, technology or service will have on the diagnosis and treatment of childhood cancer
Letter of recommendation (1)
Letter of recommendation (2)
How did you learn about this award? (Please select all that apply)
Social MediaHospitalFriends and AcquaintancesOther
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