NOMINATION PAPER FOR FELLOWSHIP (FIAN)
The undersigned Fellows of the Indian Academy of Neurology respectively propose and second the here-in named candidate for election as Fellow of the Academy.
| NOMINATION PAPER FOR FELLOWSHIP (FIAN) (Specimen Application Form) | |
| Name of the candidate | |
| Life Membership Number With year of joining the IAN | |
| Designation and Address | |
| City | |
| Pin | |
| Email id | |
| Specialty | |
| Name of the Proposer | |
| Life Membership number | |
| Address | |
| Signature with date | |
| Name of person who seconds the proposal | |
| Life Membership number | |
| Address | |
| Signature with date | |