Writing & Reviewing Manuscripts - Registration Form - Spring 2018

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* 1. First Name:

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* 2. Last Name:

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* 3. Degree(s):

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* 4. E-mail:

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* 5. Primary Affiliation:

Baylor Scott & White Health Central Division

Baylor Scott & White Health North Division

Other (please specify)

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* 6. Primary Role:

Staff Physician

Resident

Medical Fellow

Post-doctoral Research Fellow

Physician's Assistant

Nursing

Nursing Student

Pharmacist

Research Scientist

Other (please specify)

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* 7. Department:

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* 8. Years of Research Experience:

Less than 1 year

1-3 years

4-6 years

More than 6 years

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* 1. First Name:

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* 2. Last Name:

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* 3. Degree(s):

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* 4. E-mail:

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* 5. Primary Affiliation:

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* 6. Primary Role:

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* 7. Department:

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* 8. Years of Research Experience:

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* 9. How many peer-review publications do you have currently?