FSVIN Nominating Form Survey

The Society of Vascular and Interventional Neurology (SVIN) offers an elevated member status of Fellow of Society of Vascular and Interventional Neurology (FSVIN), the SVIN’s esteemed category of membership. Fellow status recognizes exceptional service and contribution to the Society, academic excellence, and leadership in the field of Vascular and Interventional Neurology. Individuals who meet the requirements of this elevated membership status will add the letters, FSVIN, to their respective titles.

1.Please enter your name.(Required.)

2.Are you an FSVIN member? (Please note only FSVIN members are allowed to submit their nominations)(Required.)

3.I nominate the following individual for FSVIN.

First Name:

Last Name:

Designation(s):

Institution:

How long have you known/worked with the nominee?

In what capacity?

Please outline the applicant's contributions to the Society and/or the field of Vascular and Interventional Neurology:

Additional comments:

4.I nominate the following individual for FSVIN.

First Name:

Last Name:

Designation(s):

Institution:

How long have you known/worked with the nominee?

In what capacity?

Please outline the applicant's contributions to the Society and/or the field of Vascular and Interventional Neurology:

Additional comments:

5.I nominate the following individual for FSVIN.

First Name:

Last Name:

Designation(s):

Institution:

How long have you known/worked with the nominee?

In what capacity?

Please outline the applicant's contributions to the Society and/or the field of Vascular and Interventional Neurology:

Additional comments:

If you would like to submit an official letter of nomination, please email it to info@svin.org.

Thank you.