StemCellCourseApplication

Once you submit your Registration, you will be able to log in once we verify your application. If you do not here back from us within 24hrs, please email us at info@stemcellcourse.org

Future Course dates - TBA

Select one: STEM CELL COURSE OR NJ STEM CELL NETWORK

STEM CELL COURSE APPLICANTS ONLY:

Tuition

Academic Scientist is $1500, lower fees for students please inquire.

non-Academics please contact: info@stemcellcourse.org

(Tuition does not include airfare, or hotel)

All attachments must be in MS WORD, Adobe PDF or plain text format.

A. Personal Information

Last Name
First Name
Middle Initial
Title
Position
Institution
Address
Address 2
City
State
Zip Code
Country
Phone
Fax
Email

Password
Confirm Password

B. Research Experience

ES Cell Experience:	Mouse	Rhesus	Human	Other
Other Stem Cell Experience

Molecular Biology Experience:	Beginner	Intermediate	Advanced
Viral Experience:	Beginner	Intermediate	Advanced

A brief description of your scientific research. You can either upload a file or paste it in the text box below.

A NIH style Biosketch (maximum four pages). You can either upload a file or paste it in the text box below.

Note: Distribution of information: check box if you want to limit the information to academic sources or leave blank if we can provide the information to relevant biotech companies. This information will be used to help support the SCRC.

Limit to academic

C. Do you need assistance in obtaining human stem cells ?

1. Do you wish to arrange an MTA to obtain human embryonic stem cells

From our lab ? from Other?

2. STEM CELL SURVEY. Please let us know if you may be interested in any of the types of cells below.

Cord Blood HSCs
Placental MSCs
Bone Marrow MSCs
Human adult CNS derived glial cells
Fibroblasts Adult Skin Foreskin

Other types of human cells:
Modifications (i.e. GFP,...)

D. Attachments

Name/Email of Supervisor or Reference

Name
EMail

A summary of how the completion of this course will be implemented into your research (maximum one paragraph).You can either upload a file or paste it in the text box bellow.

Please type the verification code exactly as seen.

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Last Updated: February 2, 2013 4:56 PM