Membership Application Instructions Please complete the information below. Select An Option Institute $1200 Annually Enter Contact Information Prefix (i.e. Mr. Mrs. Dr.) First Name Last Name Suffix (i.e Jr. Sr. III) Designations MD PHD FAAN FNCS FANA FAHS CCRI FACNS FAES ASSOCIATE PROGRAM DIRECTOR DO MA VICE CHAIR MS MSC JR NEUROLOGY SECTION CHIEF RESIDENCY DIRECTOR CHIEF PEDIATRIC NEUROLOGY CLERKSHIP DIRECTOR ASSOCIATE CLERKSHIP DIRECTOR MPH CHAIR RESIDENCY PROGRAM DIRECTOR MED PROGRAM DIRECTOR FELLOWSHIP DIRECTOR EPILEPSY FELLOWSHIP DIRECTOR CLINICAL NEUROPHYSIOLOGY MD CM DPHIL NEUROINTENSIVE CARE MHPE FNP VICE CHAIR OF EDUCATION PD PEDIATRIC NEUROLOGY FELLOWSHIP TRAINING PROGRAM CHILD NEUROLOGY PROGRAM DIRECTOR VASCULAR NEUROLOGY FELLOWSHIP DIRECTOR MBS FAAP MSCE MD PHD MBBS DIVISION CHIEF OF INPATIENT NEUROLOGY VICE CHAIR INPATIENT VICE CHAIR OUTPATIENT MAS FAHA CHILD NEUROLOGY NEUROHOSPITALIST APD CHILD NEUROLOGY DIVISION CHIEF PEDIATRIC NEUROLOGY RESIDENCY PROGRAM DIRECTOR MBA FACP PHYSICIAN NA ASSOCIATE CHAIR OF RESEARCH VICE CHAIR OF DIVERSITY EQUITY INCLUSION AND JUSTICE ASSOCIATE CHAIR OF CAREER DEVELOPMENT AND LEADERSH RESIDENCY APD CPE FACMPE FACHE FCCM MSCI CLINICAL AFFAIRS FACULTY AFFAIRS CLINICAL AND TRANSLATIONAL RESEARCH MHS FRCP(C) CAE E-mail Family NameBusiness Name View Membership Terms Next Please select a valid membership option and fee item if exist Powered By GrowthZone
