Center for Innate Immunity and Immune Disease (CIIID) Membernship Application
MEMBERSHIP TYPES (PLEASE CHECK ONE BELOW) MEMBER Requirements: • Has an active sponsored research program involving innate immunity or immune disease • will make use of the CIIID Cores within their program • will contribute to the CIIID’s progress reports • will participate in CIIID activities
AFFILIATE MEMBER Requirements: • Envisions working with CIIID members and CIIID Cores in their research programs • Interested in innate immunity and/or immune disease research
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MEMBERSHIP TYPES (PLEASE CHECK ONE)
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Member
Affiliate Member
APPLICANT INFORMATION
First Name
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Last Name
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Email Address
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Institution
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Phone
Department
Mailing Address:
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Posistion:
Please describe your research (5 sentence maximum)
Areas of Research
Please select which areas you are involved in.
Signaling
Genetics
Infectious Disease
Inflammation
Autoimmunity
Cancer
CIID Core Facilities
Please select which cores you are interested in.
Signaling & Human Cell Transgenic
Immuno-informatics
Education/Outreach
Transgenic Mouse
Translation
Please write down any other areas of research you are interested in.
CIIID Seminars
Check this box if you are interested in giving a talk at an upcoming CIIID seminar.
Educational Email List
Check this box if you are interested in being involved in educational/outreach in the form of mentoring interns, giving seminars or lectures, or accepting volunteers.
CIIID Seminar Topics
What topic(s) would you discuss?