First & Middle Name

First & Middle Name

Last name

Last name

Email

Email

Confirm email

Confirm email

Phone

Phone

Nationality

Nationality

Full Academic Title / Professional Position

Full Academic Title / Professional Position

Organization / Company

Organization / Company

Department

Department

I accept to nominate this submission to the Vaccine Research Award by Moderna / FIU
I understand that if my work is awarded the prize, I will attend the Global Health Conference, in Miami, September 3-5, 2024 (travel expenses to be paid by the organizers)
I understand that if my work is awarded the prize, I will receive the sum of U$S 5,000 in a bank account by wire transfer, and that I will have full discretion in determining the utilization of the awarded funds.
I confirm that I have obtained the approval of all my co-authors to submit this paper on their names.