Winnipeg Chapter of the Society for Neuroscience Membership Application Form

* = Required Fields.

Please fill in this form and click on the "Send" button below.

Name:*
Position Title:
Telephone:*
E-mail:*
Organization/ Department:
Mailing Address:*
URL:	Note: Please copy the Web-address of your current 'Professional Profile' web page in your web browser and paste it here.
If you are a trainee, please complete:	Name of Supervisor: Department Affiliation: Degree Program: MSc PhD PDF
Category of Membership:*	1 year (Jan-Dec) 3 years Regular Membership (Faculty, clinical and research associates) $25.00 $75.00 Graduate Student / PDF Membership (Trainees) $5.00 $15.00 Other (Non-academics, technicians other interested) $5.00 $15.00

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WCSfN webmaster: www (at) sfn-manitoba.ca

Revised April 16, 2010.