Lee W. Graber Orthodontics Changing Lives Award

Submissions for the WFO Lee W. Graber Orthodontics Changing Lives Award may only be made by a WFO Fellow or WFO Student Member in good standing or a WFO Affiliate Organization in good standing.

1Name

2Contact Information

3Nominee's Information

4Submission Video

Name of Submitting WFO Orthodontist:(Required)

First Last

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Nominee's Affiliate Organization:(Required)

Nominating Affiliate Organization:(Required)

President:(Required)

Please submit a short narrative of no more than three (3) pages in length, authored by the submitting Fellow and/or their patient or WFO affiliate organization, describing how orthodontic treatment positively changed the life of the patient. The treating orthodontist’s curriculum vitae must be attached. The submitted video should be sent in MP4 or MOV format with an online file transfer service.

Do you want to submit the short narrative now?(Required)

Yes

No more than three (3) pages in length, authored by the submitting Fellow and/or their patient or WFO affiliate organization.

Upload Your Document Here:

Max. file size: 100 MB.

Docx, PDF, and TXT formats accepted.

OR you may provide a valid link to the document.

*Google Drive link or Dropbox URL to this field.

No worries. Please email the video link to wfo@wfo.org later on.

E-mail submission of the written documents is preferred but their submission may also be made by mail or FAX.

World Federation of Orthodontists 401 N. Lindbergh Blvd. St. Louis, MO 63141-7816 USA Fax: + 1-314-985-1036 Email: wfo@wfo.org

Name

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