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:
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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
WCSfN
webmaster:
www (at) sfn-manitoba.ca
Revised April 16, 2010.