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  
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