Application for CCBBI Affiliate Status

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Name of Faculty Member

Title

Professional or Department website

Neuroimaging Research Program

Please provide a paragraph detailing your research program. Faculty members with an active neuroimaging lab will be prioritized.

Service Commitment

Please provide a paragraph detailing your service commitment to the Center. Please visit the Center website to learn about initiatives and activities at the Center. CCBBI Affiliates are expected to actively contribute by serving on Center committees, participating in the Center's ADNiR program as mentors, and attending and engaging with external speakers invited for the CCBBI Users' Talk Series.

Do you wish to receive email announcements and the monthly newsletter?

Yes

Please submit this form along with a copy of your CV to be considered for affiliate status at CCBBI.

Please send a photo of yourself if you would like to include one on your membership profile on the CCBBI website.

Upload your CV and photo here

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If you do not wish to be listed on CCBBI's website, please select no.

Date

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