2016 Membership Application and Renewal Form
= Required Fields.
Please fill in this form and click on the "Send" button below.
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,
Name of Supervisor:
Membership fees are for the calendar year (January-December).
Postdocs, Residents, Technicians, Research Associates
All-inclusive Lab Rate
(enter member names below and name of supervisor above)
(for all-inclusive lab rate)
For all-inclusive lab rate, enter one lab member per line, as:
first and last name
information for each person please!
For renewals, please provide your membership ID number, e.g. RC-XXX.
Select one of the following payment methods:
Secure Credit Card Payment
* Please make cheque payable to:
St. Boniface Hospital, c/o Winnipeg Chapter Society for Neuroscience
and send to:
Winnipeg Chapter Society for Neuroscience
R4046 - 351 Tache Ave., Winnipeg, MB R2H 2A6, Canada
Enter U of M FOAP #:
(new member of lab that already paid all-inclusive lab rate)
Revised February 12, 2016
© The Winnipeg Chapter of the Society for Neuroscience.