UCNS Communications Form

UCNS Communications Request

Thank you for your interest in receiving future UCNS electronic updates. The electronic newsletter, UCNS Update, is delivered approximately 1-2 times per month. The UCNS does not rent or sell our email lists.

Question Title

* 1. Contact Information:

Full Name and Designation (MD, PhD, etc)

Institution or Practice Name

Street Address #1

Street Address #2

City

State

Zip Code

Email Address:

Telephone:

Question Title

* 2. Primary medical specialty:

Neurology

Internal Medicine

Anesthesiology

Oncology

Psychiatry

Neurosurgery

Internal Medicine

Other:

Question Title

* 3. UCNS recognized subspecialty area(s) of interest:

Autonomic Disorders

Behavioral Neurology & Neuropsychiatry

Clinical Neuromuscular Pathology

Geriatric Neurology

Headache Medicine

Neurocritical Care

Neuroimaging

Neuro-oncology

Neural Repair and Rehabilitation

Question Title

* 4. I am interested in receiving information regarding UCNS:

Certification

Continuous certification requirements

Accreditation for a fellowship program

Fellowship opportunities

Other (please specify)