Board of Directors Nomination Form - ANA: American Neurological Association

Nominee Information

Credentials*

Please use all uppercase letters (MD, PhD) and refrain from using periods (i.e. M.D., P.h.D)

Institution*

Please provide the institution where you are currently employed, not where you received your education. Please refrain from using acronyms (i.e. UCLA, GSU, FSU)

Email*

When did you join the ANA?*

How many times have you attended the ANA Annual Meeting?*

What year did you last attend the ANA Annual Meeting?*

Please list any ANA board positions you have held and the committees you have served on, both past and present:*

Please provide your biographical information, including your professional background, education, and any relevant experience:*

Upload your CV:*

Max. file size: 50 MB.

Upload your Personal Statement indicating why you wish to serve as an officer or director on the ANA Board of Directors:*

up to 250 words

Max. file size: 50 MB.

For which role would you like to be considered?*

Institution

Email