Junior & Early Career Member Referral Participation Form

Thank you for your interest in participating in the ANA Membership Referral program. To participate, please guidelines below then complete and submit this form. 

Please note: If you would like to submit the information at a later date, please click on SAVE DRAFT at the bottom of the form. You  can return back to the form at any time prior to the deadline to complete and submit your form

PARTICIPANTS IN THE  'ASSOCIATE' CATEGORY
Refer five (5) new members, in the Associate or Member category by August 1, 2022 and receive one (1) complimentary registration to the ANA2022 Annual Meeting.
PARTICIPANTS IN THE 'MEMBER' CATEGORY
Refer seven (7) new members in the Associate, Member or Fellow category by August 1, 2022 and receive one (1) complimentary registration to the ANA2022 Annual Meeting.

 

ANA Membership Category Descriptions:

Fellow ($425/year)
Upon promotion to associate professor, full professor, or Chair of an ACGME-accredited or Canadian equivalent Neurology Department, one is eligible to become a Fellow of the American Neurological Association.  A physician-scientist or neuroscientist devoted to advancing the goals of academic neurology with an appointment as an Associate Professor, Full Professor, or Chair of an ACGME- accredited or Canadian equivalent Neurology Department in the United States or Canada is eligible.
 
Member ($170/year)
An individual appointed to their first faculty position in an ACGME-accredited or Canadian equivalent Neurology Department in the United States or Canada is eligible to be a Member of the Association. A physician-scientist or neuroscientist devoted to advancing the goals of academic neurology with an appointment with a faculty position as an Instructor or Assistant Professor in an ACGME- accredited or Canadian equivalent Neurology Department in the United States or Canada is eligible.
 
Associate ($50/year)
Open to individuals holding an MD, Ph.D., MD/Ph.D. degree engaged in an organized training program at ACGME-accredited neurology or neuroscience-related department. 

Referral Form
Participant Information
Referral Names
Additional Referral Names (optional)
Referral Info