Fellows Nomination Form - ASET - The Neurodiagnostic Society

Please complete this online submission form in its entirety. You can either upload or type your written statement supporting the nomination. Nominations deadline is February 28, 2025. Please contact Kevin Helm [email protected] if you have any questions.

Part I: Nominator Contact Information

Your Name: *

First

Last

Phone:

Email: *

ASET Member ID

How to find your ASET ID…

Part II: Nominee Information

Name of Nominee: *

First

Last

Employer:

Job Title:

Phone:

Email: *

Mailing Address:

Address Line 1

Address Line 2

City

State

Zip Code

Part III: Required Documentation

Either submit or upload along with this completed online form, a brief typed statement (no more than 500 words) supporting the nomination by speaking to how the nominee meets the nomination criteria in general by having distinguished him/herself in service to ASET, service to the neurodiagnostic profession, and as an ambassador exemplifying and advancing the neurodiagnostic profession.

Provide Statement: *

Upload Statement
Type Statement