53902 Judging Recruitment Survey for 53rd Annual MSBRF

CONTACT INFORMATION

This survey is intended to gauge your availability for judging of the 53rd Annual Midwest Student Biomedical Research Forum.

Abstracts will be judged in February 2022.

The Forum will be held IN PERSON at the Mike and Josie Harper Center for Student Life and Learning on Saturday, March 5, 2022.

Contact Information

Question Title

* Full Name
(Please list your name exactly as you want it to appear on all promotional materials)

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* Credentials
(Please list your credentials exactly as you want them to appear on all promotional materials)

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* Email

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* Phone (Please include the area code)

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* Affiliation:

Creighton University

University of Nebraska Medical Center

Veterans Administration Medical Center

Other (please specify)

53902 Judging Recruitment Survey for 53rd Annual MSBRF

CONTACT INFORMATION

Question Title

* Full Name
(Please list your name exactly as you want it to appear on all promotional materials)

Question Title

* Credentials
(Please list your credentials exactly as you want them to appear on all promotional materials)

Question Title

* Email

Question Title

* Phone (Please include the area code)

Question Title

* Affiliation:

Question Title

* Department Name

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* Department Phone
(Please include the area code)

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* Campus / Zip Code

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* Please provide a brief description of your personal research interests:

Question Title

* Full Name(Please list your name exactly as you want it to appear on all promotional materials)

Question Title

* Credentials (Please list your credentials exactly as you want them to appear on all promotional materials)

Question Title

* Email

Question Title

* Phone (Please include the area code)

Question Title

* Affiliation:

Question Title

* Department Name

Question Title

* Department Phone(Please include the area code)

Question Title

* Campus / Zip Code

Question Title

* Please provide a brief description of your personal research interests:

* Full Name
(Please list your name exactly as you want it to appear on all promotional materials)

* Credentials
(Please list your credentials exactly as you want them to appear on all promotional materials)

* Department Phone
(Please include the area code)