This award can be given by the President or any Section Chair, during an appropriate ceremony, to more than one candidate (dentist or non-dentist) to show recognition for special service or contributions to the Academy or a Section.

The name and address of the nominee must be submitted to the Central Office at least six (six) weeks prior to the award presentation.

Honoree Information

First Name *

Last Name *

Degree

Email Address *

Briefly describe reason for the award *

Presentation date *

Submitted by

Select Your Region *

Select Your Section

Section Chair Person First Name *

Section Chair Person Last Name *

Phone Number *

Email address *

Date submitted

Address you would like the plaque shipped to *

Address you would like the plaque shipped to: Line 2

City *

State / Province / Region *

Postal / Zip Code *

Country *

Date submitted *

Please Remember

Take photos of your Awardee as well as your event to send with your annual report to the International Office for publishing in Dental World and on the website.

Success! Your award information has been sent.

There was an error trying to send your award information. Please contact us at +1-240-658-8070 or centraloffice@fauchard.org.

Special Appreciation Award

Honoree Information

Submitted by

Please Remember

Region 1 - Europe

Region 2 - Northeast USA

Region 3 - Southeast USA

Region 4 - Midwest USA

Region 5 - Western USA

Region 6 - Canada

Region 7 - Latin America

Region 8 - Australasia

Region 9 - Asia

Region 10 - Central USA

Region 11 - Africa

Autonomous Region