Your First name (required)

    Your Last name/surname (required)

    Your Email (required)

    Your Affiliation/Institution (required)

    Your Lab/Department

    Male/Female (required)

    Your Photo (required) (1MB max file size)

     

    Completed academic degrees (required)

    Registration type (required)

    Your profile (required)

    Other profile:

     

    Interest fields:

     

    Clinical populations you are interested in:

    Other clinical population interest(s):

     

    Short Curriculum Vitae (1-2 pages)

    Your CV (required) (2MB max file size)

    Have you previously attended SSNR?

     

    Your Comments

     

    Please notify us if you have any rooming/meal considerations (ex: vegetarian/vegan, will be arriving/leaving on ____ dates, preferred roommate for hotel room, etc.)

     


    Phone country code: +

    Phone number:

     

    Subscribe to SSNR’s MailChimp email list (updates, notification of acceptance, etc.)

    * indicates required