Application for ICTR Membership
* Required Fields
First Name
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Last Name
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Date
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Degree
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Title
Department/ Division
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Telephone
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Fax
Mailing Address
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Email
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Role
Student
Post-doc
Resident
Faculty
Fellow
PA
Nurse
Physician
Pharmacist
Veterinarian
Other
Affiliation
BCM
Rice
SLEH
TCH
UH
UTH
VA
Kelsey Seybold
Other
CTSA Programs of interest (check all that apply)
Translational Technologies:
Neuroimaging
Microscopy
Metabolomics
Cell & Gene Therapy
Microfluidics/''lab on a chip''
Proteomics
Nanotechnology
Metabolic/Nutritional Analysis
Regulatory Knowledge and Support
Research Design Support/Clinical Trials
Research Ethics
Biostatistics
Epidemiology
Comparative Effectiveness Research
Health Services Research
Community Engagement
Biomedical Informatics
Computational Informatics
Biobanking
Subject Recruitment Support
Training/Mentoring in Clinical Research
Training/Mentoring in Translational Research
Educational Programs in which you participate
MD
PHD
MSTP
CSTP
TBMM
K12
T32
Other
Role
Student or Trainee
Mentor
Didactic Instructor
Type of Clinical Research
Laboratory
Imaging
Surgical
Cell & Gene Therapy
Phase 1
Phase 2
Phase 3
HSR
Comparative Effectiveness
Need for IND or IDE
IND
IDE
Need for translation services
*
Yes
No
Briefly state your current specific area of scientific interest or expertise
Identify any comments or suggestions for the ICTR
SUBMIT