2026 Fellowship Award Convocation Reply Form

Please complete this form by Friday, May 1, 2026. Email education@agd.org if you have any questions.

Convocation attendance is mandatory for Fellowship Awardees.
Approved 2026 Fellowship Award candidates have three opportunities to attend a Convocation Ceremony (AGD2026, AGD2027, or AGD2028)

AGD Member ID

First Name

Constituent Name

Middle Initial

Last Name

Please write out the name of your constituent, do not put the regional number.

Select preferred option

I WILL attend Convocation Ceremony June 27, 2026, in Las Vegas, Nevada

I WILL NOT attend Convocation Ceremony June 27, 2026, in Las Vegas, Nevada

If you are not attending, no need to fill out the remainder of the form.

Please confirm how you would like your name to appear on your Fellowship Award Plaque: Note: There is a space limit on the award plaque

Please confirm your mailing address to receive your Fellowship Award Plaque. Shipping addresses must be updated at least 4 weeks before the convocation ceremony.

Name

Address

City

State/Providence

Zip Code

Is your spouse or other family member receiving the Fellowship Award:

Yes

If yes, please enter the name and the relation of the person

How many guest(s) will you invite to the Convocation Ceremony?

Guest #1

Guest #2

Guest #3

Guest #4

Guest #5

Family members receiving different awards/recognitions cannot be seated together, but AGD staff will provide direction so you can have your photos taken together on-stage with the AGD president.

Sponsored by AGD Corporate Sponsors:

care credit