Black Microbiologists Association (Black in Microbiology) Membership Form
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Email *
First name *
Last name *
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Please confirm that you self-identify as Black *
Credentials (BS, MS, PHD, MD, etc.)
Education (Please put the highest level) & Institution *
Country of Residence (e.g. USA, UK, South Africa, etc.)
Please indicate your current employment sector (Academia, Industry, Government, Other, etc.)
Institution/Organization (e.g. UAB, Merck, CDC, etc.) *
Department/Program (e.g. Department of Microbiology, Molecular Micro & Microbial Pathogenesis, etc. If not applicable, enter 'NA') *
Position title (e.g. Graduate Student, Postdoc, Professor, Senior Scientist, Science Writer, Liaison, Technician, etc.) *
Subdiscipline (Bacteriology, Virology, etc.)
Please use 3-5 key words to describe your research interests
Please provide a short introduction (200 words or less) about yourself that you would like to appear on our membership database (be sure to include an email address if you would like people to be able to contact you). *
Social Media handles (eg. Twitter, IG, LinkedIn, etc.)
What kinds of activities/events do you hope to see from this community? *
Members are invited, but not required, to volunteer for various organizational activities. Please indicate your areas of interest. (Check all that apply)
Would you like to be made aware of seminar opportunities?
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Would you like to be made aware of job opportunities?
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If you would like a photo to appear in our membership database, Please provide us a photo (.jpg or .png) via email to Please put FIRST NAME-LAST NAME-MEMBERSHIP in the subject line.
A copy of your responses will be emailed to the address you provided.
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