ASPN Traveling Fellowship

First Name
Last Name
Institution
Address
City
State
Zip If not applicable please enter "N/A".
Country
Email
Phone

Training completion date

Current position

Practice mix (% peripheral nerve)
Please record the mix of your practice and specifically indicate the percentage of time focused on peripheral nerve surgery and/or peripheral nerve research.


Please indicate your lab focus.


Upload statement of intent
This statement should be a maximum of 200 words and must include potential plans, goals of the Fellowship, current peripheral nerve influences, and anticipated improvements of additional skills desired to add to or improve practice.

I confirm I am an ASPN member in good standing and within my first 11 years of training.
 

 
 
American Society for Peripheral Nerve
500 Cummings Center, Suite 4400, Beverly, MA 01915
Phone: 978-927-8330 | Fax: 978-524-0461