Authorization to use the information provided in this form on the Cancer Research Society’s website

Please note that by filling in and submitting this survey, you are giving us permission to use this information on the Cancer Research Society’s website and in various printed documents. Furthermore, you are agreeing to provide any updates on the progress of your research and on all publications made possible thanks to funds received from the Cancer Research Society.

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* 1. PIN of your Application

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* 2. Contact details

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* 3. Funding Program

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* 4. Partnership (if applicable)

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* 5. What is your domain of research (5 lines max) ?

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* 6. Please provide some of your career highlights (5 lines max)

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* 7. Recognition and Awards (from the past 2 years only - 5 lines max)

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* 8. Please describe why you decided to pursue a career in cancer research (5 lines max)

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* 9. What would be your biggest dream or goal for your cancer research projects if you had unlimited time and resources?

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* 10. Attach a clear, good resolution photo, ideally in a laboratory setting - no selfie please!

GIF, JPEG, JPG, PNG file types only.
Choose File

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* 11. Indicate the photo credit

Note: Both the Cancer Research Society and its funding partners must be acknowledged in all manuscripts, presentations, posters and other forms of communications (including laboratory websites) that present data generated from this grant. Consult your official grant offer letter, or contact us at grants@src-crs.ca for preferred attribution wording and logos.

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* 12. I authorize that my information (including my photo) be used for publication.

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* 13. The Cancer Research Society may invite researchers to meet with donors at fundraising events. Please indicate if you are interested in the following activities:

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