Tarrant County Medical Society
2021 Gold-Headed Cane Award
Nomination Form
Nominations must be received by Friday, April 23, 2021
This is the call for nominations for the TCMS 2021 Gold-Headed Cane Award. To be eligible,
the nominee must be a current member of TCMS and have been a TCMS member for 15
years. A list of eligible members is available on the TCMS website (www.tcms.org).
This democratic process allows each current TCMS member to nominate one candidate by
submitting the eligible physician’s name along with a statement supporting the qualifications of
the candidate (100 words or less). Both a supporting statement and the nomination form are
required for each nomination. The supporting statement can be filled in along with the
nomination form on TCMS’s website or submitted on a separate sheet of paper with the paper
nomination form. If filled in electronically, save the nomination form and the accompanying
statement to your computer and then attach them to an email for submission.
Every eligible nominee will appear on the ballot.
All members of TCMS are eligible to vote once the ballot has been published in the Tarrant
County Physician and TCMS NewsFlash. Traditionally, no campaigning is conducted by the
candidate or any supporter.
Factors to consider are excellence in clinical practice, participation in organized medicine,
participation in the community, integrity in all activities, and additional qualities and
contributions which support consideration as an exemplary physician.
The deadline for receipt of nominations in the TCMS office is Friday, April 23, 2021, whether by
mail, email, or fax.
Name of Physician nominated__________________________________________
(Please print legibly)
Nominating Physician (must be a TCMS member): _________________________
(Please print legibly)
Phone__________________ Email______________________________________
Completed forms and statements can be mailed to TCMS, 555 Hemphill Street, Fort Worth 76104,
emailed to mbriggs@tcms.org, or faxed to (817) 732-3033