Young Neurosurgeons Forum


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Young Neurosurgeons Forum

  1. 1. Membership Application Form Young Neurosurgeons Forum Membership of Young Neurosurgeons Forum, Pakistan is open to all Pakistani neurosurgeons who are within ten years of acquiring their first neurosurgical qualification. Those neurosurgical residents/trainees, who have completed their residency/training and are eligible to appear in their neurosurgical postgraduate examination can also join as full members of the Forum. Section 1 – BIOGRAPHICAL DATA Full Name Position Institution Institutional Address City Post Code Telephone ( ) Fax ( ) Home Address City Post Code Telephone ( ) Fax ( ) Email @ Preferred Mailing Address Home Office Page 1
  2. 2. Date of Birth Nationality Page 2
  3. 3. Section 2 – PROFESSIONAL DATA Qualifications Basic Professional* Date of first neurosurgical postgraduate qualification* * In case of residents / trainees, please give qualification working for & the expected date of examination Institution from which neurosurgical qualification has been (or is expected to be) obtained Experience in Neurosurgery: Post-Qualification (in years & months) Total duration Position Institution Experience in Neurosurgery: Pre-Qualification (in years & months) Total duration Position Institution Publications (including dissertation/thesis) Please attach additional pages if necessary Interests (Neurosurgical) Interests (Other) For office use Admitted Rejected Signature of the YNF official YNF Seal Designation Date Page 3