Residency Directors Member Referral Participation Form

Thank you for your interest in participating in the Residency Director's ANA Membership Referal program. This program is intended for Residency Directors to encourage their residents and trainees to join the ANA as Associate* members and enjoy the benefits that come with membership including:

To participate:

  • Refer at least seven (7) new members in the Associate* category (resident/trainee) by August 1, 2022 
  • Referred members must be reflected as active ANA members by September 1, 2022 *
    • ​The referring member is responsible to ensure the individual they referred become members by the September 1st deadline
  • Once the minimum number of new Associate members is reached you will be notified.
  • Once notified you can choose between receiving one (1) complimentary registration to the ANA2022 Annual Meeting or complementary ANA membership for the 2023 calendar year 

*Associate members are  those individuals holding an MD, Ph.D., MD/Ph.D. degree engaged in an organized training program at ACGME-accredited neurology or neuroscience-related department. Membership is $50/year

 

Referral Form

Participant Information

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Additional Referral Names (optional)
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