EAN INDIVIDUAL MEMBERSHIP APPLICATION 2018 - Profession: First name: Last name: Institution: Department: Street: City & Postal code: Country: Nationality: Phone: Email: Membership category / membership fee for Documents attached 2018 Full Individual Member / CV €150 CV, congress certificates, *letter of recommendation Fellow of EAN (FEAN) / €250 from 2 FEANs CV, signed letter of supervisor Resident & Research Fellow / €45 Please state your residency starting date ________ Undergradute Student / FREE CV, student ID card Retired Individual Member / CV, proof of retirement €75 Corresponding Individual Member / CV €150 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 to be shipped to the €75,- above address. Abschicken an: Membership (membership@ean.org) ………………………… ……………………………………………………… Date Signature
EAN - INDIVIDUAL MEMBERSHIP APPLICATION 2018 Profession: First name: Last name: Institution: Department: Street: City & Postal code: Country: Nationality: Phone: Email: Membership category / membership fee for 2018 Documents 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@ean.org) ………………………… ……………………………………………………… Date Signature
ean-form.docx