ICNApedia - Subscribe for ICNA Life Membership [Free]

Avatar

Email *

Password*

Retype Password *

Prefix *

First Name *

Middle Name

Last Name *

Organization *

Position/Designation *

Address *

Address2

City *

Zip *

Country *

State *

Currently in training *

Not in training

Yes - Medical School

Yes - Resident

Yes - Fellow

Yes - Other

Not applicable

Phone

Cell Phone

Are you a faculty member in a medical school or neurology department ? *

No

Yes Primarily Clinical

Yes Primarily Education

Yes Primarily Research

Yes Primarily Administrative

Indicate in which practice arrangement you spend the majority of your clinical time *

University based group

Multispeciality Group

Government Hospital or Clinic

Other Public or Private Hospital or Clinic

Solo Practice

Staff Model HMO

I do not have a practice

Curriculum Vitae *

Referee 1 *

Referee 1 (Email) *

Referee 2 *

Referee 2 (Email) *

Comment

By signing up to this subscription plan and agreeing to the Privacy Policy you agree to ICNApedia and the ICNA storing your information.

Please also subscribe me to the ICNA Newsletters

I accept

Existing user? Please login

New User? Please register

Account Information

Join Our Newsletter

Log in