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EAN - INDIVIDUAL MEMBERSHIP APPLICATION 2018Title:Profession:First name:Last name:Institution:Department:Street:City & Postal code:Country:Nationality:Phone:Email:Membership category / membership fee for 2018Documents attached? Full Individual Member / €150? CV? Fellow of EAN (FEAN) / €250? CV, congress certificates, *letter of recommendation from 2 FEANs? Resident & Research Fellow / €45? CV, signed letter of supervisor Please state your residency starting date ________? Undergradute Student / FREE? CV, student ID card? Retired Individual Member / €75? CV, proof of retirement? Corresponding Individual Member / €150? CV? I am a member of the American Academy of Neurology (AAN).European Journal of Neurology?I want to purchase the printed EJoN (Jan-Dec 2018) at a reduced fee of €75,- to be shipped to the above address.Abschicken an: Membership (membership@)…………………………………………………………………………………DateSignature ................
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