ASPN Travelling Fellowship

First Name
Last Name
Zip If not applicable please enter "N/A".

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.

Please upload your CV

Please upload a letter of support for your application from an ASPN member.

I confirm I am an ASPN member in good standing and within my first 10 years of training (as of 2023).

American Society for Peripheral Nerve
500 Cummings Center, Suite 4400, Beverly, MA 01915
Phone: 978-927-8330 | Fax: 978-524-0498