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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 |