The Voice of Academic Neurology's Leaders

Institutional Profile Form

All membership category positions listed below are covered by the AUPN annual dues and therefore are entitled to all AUPN benefits. This includes receiving the weekly Saturday emails.

If there is not an individual in a specific role, please leave blank.

Please contact neuro@aupn.org with questions.

Institution Contact Information:

Institution Name *
Institution Address
City
State
Zip
Phone

Neurology Department Chair (billing contact)

Chair Name (first, last)
Suffix (MD, PhD, etc.)
Nickname (if applicable)
Email
Phone (if different than above)

Residency Program Director

Program Director Name (first, last)
Suffix (MD, PhD, etc.)
Nickname (if applicable)
Email
Phone (if different than above)

Clerkship Director

Clerkship Director Name (first, last)
Suffix (MD, PhD, etc.)
Nickname (if applicable)
Email
Phone (if different than above)

Child Neurology Residency Program Director

Child Neurology Program Director Name (first, last)
Suffix (MD, PhD, etc.)
Nickname (if applicable)
Email
Phone (if different than above)

Research Program Director

Research Program Director Name (first, last)
Suffix (MD, PhD, etc.)
Nickname (if applicable)
Email
Phone (if different than above)

VA Director

VA Director Name (first, last)
Suffix (MD, PhD, etc.)
Nickname (if applicable)
Email
Phone (if different than above)





Fields marked with * are required.

Your form submission WILL be encrypted using SSL to ensure your privacy.

MEMBERSHIP
EDUCATION
JOB BOARD
5841 Cedar Lake Road, Suite 204 | Minneapolis, MN 55416 | 952-545-6724 | neuro@aupn.org
© 2020 Association of University Professors of Neurology. All rights reserved. Articles of Incorporation | Terms of Use
Reset password
NEWS
VIEW MORE