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Faculty Membership Application Form
This form is for faculty at Washington University to apply to join as members of the Center of Regenerative Medicine. CRM website:
https://regenerativemedicine.wustl.edu/
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Email
*
Your email
Name (First Last)?
*
Your answer
Degrees(s)
Your answer
Academic Title
Your answer
Primary department and/or division
Your answer
Secondary appointments
Your answer
Office location
Your answer
Campus box #
Your answer
Administrative Assistant (if relevant)
Your answer
Briefly describe your research interests. Include a one-‐two sentence general description that will be used on the Center of Regenerative Medicine Website.
Your answer
Describe how your research and career would benefit from being a member of the CRM
Your answer
In which of the following areas does your research fit (choose all that apply)?
Cell and Tissue Engineering
Development, Degeneration, and Aging
Embryonic and Adult Tissue Stem Cells
Reprogramming and Epigenetics
Please give the names, titles, and email addresses of students, postdocs, and staff in your lab
Your answer
Please email us at crminfo@email.wustl.edu to let us know that you have completed this form (just a simple "Membership form submitted!" in the subject is fine)
Your answer
A copy of your responses will be emailed to the address you provided.
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