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 *
Name (First Last)? *
Academic Title
Primary department and/or division
Secondary appointments
Office location
Campus box #
Administrative Assistant (if relevant)
Briefly describe your research interests. Include a one-­‐two sentence general description that will be used on the Center of Regenerative Medicine Website.
Describe how your research and career would benefit from being a member of the CRM
In which of the following areas does your research fit (choose all that apply)?
Please give the names, titles, and email addresses of students, postdocs, and staff in your lab
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)
A copy of your responses will be emailed to the address you provided.
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