NOMINATION PAPER FOR FELLOWSHIP(FIAN)

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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

Name Of Candidate:*

Life Membership No:*

With year of joining:

Designation:*

Address:*

City:*

Pin:*

Email id:*

Specialty:*

Name of Proposer 1:*

Life Membership number of Proposer 1:*

Address:*

Date:*

Name of Proposer 2:*

Life Membership number of Proposer 2:*

Address:*

Date:*

List of educational qualifications and year: *

--- Select year --- 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021

Add Qualification

Number of publications, Book chapters and Title of Books edited*

Copies of five of your best papers with citations*

Citations, h-index. i-10 indexof your publications (enclose evidence in support)*

Research projects funded by various funding authorities*

Awards, Fellowships & Orations*

Contribution to IAN (in not more than 100 words)*

Extracurricular activities (health camps, TV or radio Talks, talks on health issues to lay public( in 100 words)*

Biodata:*
(Your CV should have Sr.no. 1 to 8 essential items. Given in "FIAN Rules & Regulation" Please click here to access)

   

The last date to receive the application would be Sunday, 31^st January 2021.