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ACHRI Trainee Registration Form Please complete the form below and return via email to: srikhy@ucalgary.ca. Once registered you will be able to receive information from ACHRI about trainee opportunities and events. Only registered trainees will be eligible for funding through ACHRI or its education initiatives, including the CIHR Training Program. TRAINEE: PERSONAL INFORMATION NAME:

PRESENT ADDRESS:

TELEPHONE:

EMAIL ADDRESS:

START AND END DATES OF YOUR DEGREE OR FELLOWSHIP PROGRAM:

DEGREE PROGRAM / DISCIPLINE (e.g., Medical Genetics, Biochemistry, Behavioural Neuroscience):

FROM (DD/MM/YY): TO (DD/MM/YY):

YOU ARE ENROLLED IN A: MASTER’S PROGRAM PhD PROGRAM POSTDOCTORAL FELLOWSHIP

PLEASE IDENTIFY YOUR SUPERVISOR & THEIR DEPARTMENT

IF APPLICABLE, PLEASE INDICATE WHO IS ON YOUR THESIS COMMITTEE:


ACADEMIC RECORD DEGREES AND CERTIFICATIONS List all degrees/diplomas that you have completed. DATES DEGREE/ DIPLOMA

DISCIPLINE

INSTITUTION

LIST ALL PEER-REVIEWED PUBLICATIONS THAT YOU HAVE PUBLISED.

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