Sign-Up Form for CPSR NTA

By completing this form, your information will be added to the CPSR National Trainee Association database for internal use to facilitate collaboration and your email address will be added to our email distribution list (e.g., NTA activities, CPSR newsletters).

As part of the NTA, we strive to encourage networking and collaboration. We may make some of your information available to other trainees in an effort to encourage collaboration (e.g., sharing email addresses, or areas of research interest). 

IF YOU DO NOT WANT US TO SHARE YOUR INFORMATION, PLEASE LET US KNOW.

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* 1. Title

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* 2. First Name

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* 3. Last Name

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* 4. Affiliations/Institutions

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* 5. Supervisor(s) Name

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* 6. Trainee Status

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* 7. Regarding your current trainee status, please choose which category fits you best:

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* 8. OPTIONAL - When do you expect to complete this stage of your training? (MM/DD/YYYY)

Date

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* 9. At what email address would you like to be contacted?

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* 10. Do you agree to have your email address added to the CPSR distribution list for newsletters, announcements, etc.

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* 11. Research Focus

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* 12. Research Focus Area

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* 13. Research Summary Description

Please provide a few sentences describing your area of research study (Max 50 words)

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* 14. Comments or ideas

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* 15. Question Deleted - please ignore

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* 16. Question deleted - please ignore

Please direct any questions to:
Farrell Leibovitch, MSc.
Director, Research and Training Programs
Canadian Partnership for Stroke Recovery
Tel: 416-480-6100 ext 7548
Email: farrell@canadianstroke.ca

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