YNIS Committee Application

First Name *

Last Name *

Designation (MD, PhD, etc)

Email *

Training Level *

Enter required value Established (>20 years) Established (11-20 years) Mid-Career (4-10 years) Early Career (1-3 years) Fellowship Resident Medical Student N/A

Specialty *

Enter required value Radiology Neurology Neurosurgery Cardiology N/A

Current Position *

Professional Goals *

Which subcommittees are you interested in joining? *

Choose up to 3.

Education

Networking & Mentorship

Social Media

Community Engagement

Research

Member-at-Large

Why are you a good fit for these subcommittees? *

If you have served or contributed to the SNIS or YNIS committees in the past, please describe how: